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KEYSTONE EMP WELFARE BENEFIT PLAN II 401k Plan overview

Plan NameKEYSTONE EMP WELFARE BENEFIT PLAN II
Plan identification number 502

KEYSTONE EMP WELFARE BENEFIT PLAN II Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

KEYSTONE CONSOLIDATED INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:KEYSTONE CONSOLIDATED INDUSTRIES, INC.
Employer identification number (EIN):370364250
NAIC Classification:332900

Additional information about KEYSTONE CONSOLIDATED INDUSTRIES, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1968-08-06
Company Identification Number: 0002773806
Legal Registered Office Address: 13355 NOEL RD STE 1550

DALLAS
United States of America (USA)
75240

More information about KEYSTONE CONSOLIDATED INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEYSTONE EMP WELFARE BENEFIT PLAN II

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01BERT E. DOWNING, JR.
5022017-01-01BERT E. DOWNING, JR.
5022017-01-01
5022016-01-01BERT E. DOWNING, JR.
5022016-01-01
5022015-01-01BERT E. DOWNING, JR.
5022014-01-01BERT E. DOWNING, JR.
5022014-01-01BERT E. DOWNING, JR.
5022013-01-01BERT E. DOWNING, JR. BERT E. DOWNING, JR.2014-10-06
5022012-01-01BERT E. DOWNING, JR. BERT E. DOWNING, JR.2013-09-04
5022011-01-01BERT E. DOWNING, JR. BERT E. DOWNING, JR.2012-08-20
5022009-01-01BERT E. DOWNING, JR. BERT E. DOWNING, JR.2010-09-20

Plan Statistics for KEYSTONE EMP WELFARE BENEFIT PLAN II

401k plan membership statisitcs for KEYSTONE EMP WELFARE BENEFIT PLAN II

Measure Date Value
2022: KEYSTONE EMP WELFARE BENEFIT PLAN II 2022 401k membership
Total participants, beginning-of-year2022-01-0110
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-0110
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0110
2021: KEYSTONE EMP WELFARE BENEFIT PLAN II 2021 401k membership
Total participants, beginning-of-year2021-01-0110
Number of retired or separated participants receiving benefits2021-01-0110
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0110
2020: KEYSTONE EMP WELFARE BENEFIT PLAN II 2020 401k membership
Total participants, beginning-of-year2020-01-0114
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-0110
Total of all active and inactive participants2020-01-0110
2019: KEYSTONE EMP WELFARE BENEFIT PLAN II 2019 401k membership
Total participants, beginning-of-year2019-01-0114
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-0114
Total of all active and inactive participants2019-01-0114
2018: KEYSTONE EMP WELFARE BENEFIT PLAN II 2018 401k membership
Total participants, beginning-of-year2018-01-0117
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-0117
Total of all active and inactive participants2018-01-0117
2017: KEYSTONE EMP WELFARE BENEFIT PLAN II 2017 401k membership
Total participants, beginning-of-year2017-01-0117
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0117
Total of all active and inactive participants2017-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
2016: KEYSTONE EMP WELFARE BENEFIT PLAN II 2016 401k membership
Total participants, beginning-of-year2016-01-0118
Number of retired or separated participants receiving benefits2016-01-0117
Total of all active and inactive participants2016-01-0117
2015: KEYSTONE EMP WELFARE BENEFIT PLAN II 2015 401k membership
Total participants, beginning-of-year2015-01-0122
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-0118
Total of all active and inactive participants2015-01-0118
2014: KEYSTONE EMP WELFARE BENEFIT PLAN II 2014 401k membership
Total participants, beginning-of-year2014-01-0125
Number of retired or separated participants receiving benefits2014-01-0122
Total of all active and inactive participants2014-01-0122
2013: KEYSTONE EMP WELFARE BENEFIT PLAN II 2013 401k membership
Total participants, beginning-of-year2013-01-01409
Number of retired or separated participants receiving benefits2013-01-0125
Total of all active and inactive participants2013-01-0125
2012: KEYSTONE EMP WELFARE BENEFIT PLAN II 2012 401k membership
Total participants, beginning-of-year2012-01-01418
Total number of active participants reported on line 7a of the Form 55002012-01-01200
Number of retired or separated participants receiving benefits2012-01-01209
Total of all active and inactive participants2012-01-01409
2011: KEYSTONE EMP WELFARE BENEFIT PLAN II 2011 401k membership
Total participants, beginning-of-year2011-01-01430
Total number of active participants reported on line 7a of the Form 55002011-01-01194
Number of retired or separated participants receiving benefits2011-01-01224
Total of all active and inactive participants2011-01-01418
2009: KEYSTONE EMP WELFARE BENEFIT PLAN II 2009 401k membership
Total participants, beginning-of-year2009-01-01513
Total number of active participants reported on line 7a of the Form 55002009-01-01189
Number of retired or separated participants receiving benefits2009-01-01261
Total of all active and inactive participants2009-01-01450

Financial Data on KEYSTONE EMP WELFARE BENEFIT PLAN II

Measure Date Value
2022 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2022 401k financial data
Transfers to/from the plan2022-12-31$-158,412
Total income from all sources2022-12-31$5,353
Expenses. Total of all expenses incurred2022-12-31$339
Total plan assets at end of year2022-12-31$0
Total plan assets at beginning of year2022-12-31$153,398
Value of fidelity bond covering the plan2022-12-31$5,000,000
Total contributions received or receivable from participants2022-12-31$5,353
Net income (gross income less expenses)2022-12-31$5,014
Net plan assets at end of year (total assets less liabilities)2022-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$153,398
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$339
2021 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2021 401k financial data
Total income from all sources2021-12-31$51,012
Expenses. Total of all expenses incurred2021-12-31$17,452
Benefits paid (including direct rollovers)2021-12-31$10,167
Total plan assets at end of year2021-12-31$153,398
Total plan assets at beginning of year2021-12-31$119,838
Value of fidelity bond covering the plan2021-12-31$5,000,000
Total contributions received or receivable from participants2021-12-31$42,537
Net income (gross income less expenses)2021-12-31$33,560
Net plan assets at end of year (total assets less liabilities)2021-12-31$153,398
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$119,838
Total contributions received or receivable from employer(s)2021-12-31$8,475
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$7,285
2020 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2020 401k financial data
Total income from all sources2020-12-31$122,193
Expenses. Total of all expenses incurred2020-12-31$128,563
Benefits paid (including direct rollovers)2020-12-31$119,926
Total plan assets at end of year2020-12-31$119,838
Total plan assets at beginning of year2020-12-31$126,208
Value of fidelity bond covering the plan2020-12-31$5,000,000
Total contributions received or receivable from participants2020-12-31$52,137
Expenses. Other expenses not covered elsewhere2020-12-31$2,717
Net income (gross income less expenses)2020-12-31$-6,370
Net plan assets at end of year (total assets less liabilities)2020-12-31$119,838
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$126,208
Total contributions received or receivable from employer(s)2020-12-31$70,056
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$5,920
2019 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2019 401k financial data
Total income from all sources2019-12-31$137,910
Expenses. Total of all expenses incurred2019-12-31$162,591
Benefits paid (including direct rollovers)2019-12-31$154,374
Total plan assets at end of year2019-12-31$126,208
Total plan assets at beginning of year2019-12-31$150,889
Value of fidelity bond covering the plan2019-12-31$10,000,000
Total contributions received or receivable from participants2019-12-31$62,981
Expenses. Other expenses not covered elsewhere2019-12-31$2,266
Net income (gross income less expenses)2019-12-31$-24,681
Net plan assets at end of year (total assets less liabilities)2019-12-31$126,208
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$150,889
Total contributions received or receivable from employer(s)2019-12-31$74,929
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$5,951
2018 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2018 401k financial data
Total income from all sources2018-12-31$130,677
Expenses. Total of all expenses incurred2018-12-31$131,548
Benefits paid (including direct rollovers)2018-12-31$123,180
Total plan assets at end of year2018-12-31$150,889
Total plan assets at beginning of year2018-12-31$151,760
Value of fidelity bond covering the plan2018-12-31$10,000,000
Total contributions received or receivable from participants2018-12-31$62,629
Expenses. Other expenses not covered elsewhere2018-12-31$2,505
Net income (gross income less expenses)2018-12-31$-871
Net plan assets at end of year (total assets less liabilities)2018-12-31$150,889
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$151,760
Total contributions received or receivable from employer(s)2018-12-31$68,048
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$5,863
2017 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2017 401k financial data
Total income from all sources2017-12-31$117,525
Expenses. Total of all expenses incurred2017-12-31$111,699
Benefits paid (including direct rollovers)2017-12-31$103,205
Total plan assets at end of year2017-12-31$151,760
Total plan assets at beginning of year2017-12-31$145,934
Value of fidelity bond covering the plan2017-12-31$10,000,000
Total contributions received or receivable from participants2017-12-31$52,978
Expenses. Other expenses not covered elsewhere2017-12-31$2,740
Net income (gross income less expenses)2017-12-31$5,826
Net plan assets at end of year (total assets less liabilities)2017-12-31$151,760
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$145,934
Total contributions received or receivable from employer(s)2017-12-31$64,547
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$5,754
2016 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2016 401k financial data
Total income from all sources2016-12-31$44,720
Expenses. Total of all expenses incurred2016-12-31$121,605
Benefits paid (including direct rollovers)2016-12-31$112,722
Total plan assets at end of year2016-12-31$145,934
Total plan assets at beginning of year2016-12-31$222,819
Value of fidelity bond covering the plan2016-12-31$10,000,000
Total contributions received or receivable from participants2016-12-31$71,523
Expenses. Other expenses not covered elsewhere2016-12-31$2,470
Net income (gross income less expenses)2016-12-31$-76,885
Net plan assets at end of year (total assets less liabilities)2016-12-31$145,934
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$222,819
Total contributions received or receivable from employer(s)2016-12-31$-26,803
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$6,413
2015 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2015 401k financial data
Total income from all sources2015-12-31$241,352
Expenses. Total of all expenses incurred2015-12-31$228,225
Benefits paid (including direct rollovers)2015-12-31$224,122
Total plan assets at end of year2015-12-31$222,819
Total plan assets at beginning of year2015-12-31$209,692
Value of fidelity bond covering the plan2015-12-31$15,000,000
Total contributions received or receivable from participants2015-12-31$83,703
Expenses. Other expenses not covered elsewhere2015-12-31$183
Net income (gross income less expenses)2015-12-31$13,127
Net plan assets at end of year (total assets less liabilities)2015-12-31$222,819
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$209,692
Total contributions received or receivable from employer(s)2015-12-31$157,649
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$3,920
2014 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2014 401k financial data
Total plan liabilities at beginning of year2014-12-31$49,259
Total income from all sources2014-12-31$225,726
Expenses. Total of all expenses incurred2014-12-31$207,984
Benefits paid (including direct rollovers)2014-12-31$202,857
Total plan assets at end of year2014-12-31$209,692
Total plan assets at beginning of year2014-12-31$241,209
Value of fidelity bond covering the plan2014-12-31$15,000,000
Total contributions received or receivable from participants2014-12-31$105,822
Net income (gross income less expenses)2014-12-31$17,742
Net plan assets at end of year (total assets less liabilities)2014-12-31$209,692
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$191,950
Total contributions received or receivable from employer(s)2014-12-31$119,904
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$5,127
2013 : KEYSTONE EMP WELFARE BENEFIT PLAN II 2013 401k financial data
Transfers to/from the plan2013-12-31$205,988
Total plan liabilities at end of year2013-12-31$49,259
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$238,021
Expenses. Total of all expenses incurred2013-12-31$252,059
Benefits paid (including direct rollovers)2013-12-31$249,444
Total plan assets at end of year2013-12-31$241,209
Total plan assets at beginning of year2013-12-31$0
Value of fidelity bond covering the plan2013-12-31$15,000,000
Total contributions received or receivable from participants2013-12-31$107,541
Expenses. Other expenses not covered elsewhere2013-12-31$398
Net income (gross income less expenses)2013-12-31$-14,038
Net plan assets at end of year (total assets less liabilities)2013-12-31$191,950
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$130,480
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$2,217

Form 5500 Responses for KEYSTONE EMP WELFARE BENEFIT PLAN II

2022: KEYSTONE EMP WELFARE BENEFIT PLAN II 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: KEYSTONE EMP WELFARE BENEFIT PLAN II 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: KEYSTONE EMP WELFARE BENEFIT PLAN II 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: KEYSTONE EMP WELFARE BENEFIT PLAN II 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement - TrustYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: KEYSTONE EMP WELFARE BENEFIT PLAN II 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: KEYSTONE EMP WELFARE BENEFIT PLAN II 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: KEYSTONE EMP WELFARE BENEFIT PLAN II 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement - TrustYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: KEYSTONE EMP WELFARE BENEFIT PLAN II 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement - TrustYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: KEYSTONE EMP WELFARE BENEFIT PLAN II 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: KEYSTONE EMP WELFARE BENEFIT PLAN II 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: KEYSTONE EMP WELFARE BENEFIT PLAN II 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: KEYSTONE EMP WELFARE BENEFIT PLAN II 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: KEYSTONE EMP WELFARE BENEFIT PLAN II 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201404
Policy instance 1
Insurance contract or identification number201404
Number of Individuals Covered408
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $18,380
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $152,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,380
Insurance broker organization code?3
Insurance broker nameEWI, INC.
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5091243
Policy instance 2
Insurance contract or identification numberGTU 5091243
Number of Individuals Covered206
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,189
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,189
Insurance broker organization code?3
Insurance broker nameAON CONSULTING, INC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201404
Policy instance 3
Insurance contract or identification number201404
Number of Individuals Covered197
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,067
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $41,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,067
Insurance broker organization code?3
Insurance broker nameEWI RE INC.
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201404
Policy instance 1
Insurance contract or identification number201404
Number of Individuals Covered418
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $16,292
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $131,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5091243
Policy instance 2
Insurance contract or identification numberGTU 5091243
Number of Individuals Covered200
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,150
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201404
Policy instance 3
Insurance contract or identification number201404
Number of Individuals Covered185
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,423
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $44,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201404
Policy instance 1
Insurance contract or identification number201404
Number of Individuals Covered430
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $18,735
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $135,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5091243
Policy instance 2
Insurance contract or identification numberGTU 5091243
Number of Individuals Covered192
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,116
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201404
Policy instance 3
Insurance contract or identification number201404
Number of Individuals Covered186
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $8,016
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $42,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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