401k Plan data: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN plan

WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN
Plan identification number	001

WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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

WIRTZ BEVERAGE ILLINOIS BELLEVILLE has sponsored the creation of one or more 401k plans.

Company Name: WIRTZ BEVERAGE ILLINOIS BELLEVILLE

Employer identification number (EIN): 370634183

NAIC Classification: 424800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 W. ROCKWELL WIRTZ
001 2014-01-01 W. ROCKWELL WIRTZ
001 2013-01-01 W. ROCKWELL WIRTZ
001 2012-01-01 W. ROCKWELL WIRTZ
001 2011-01-01 RICHARD PALMIER
001 2009-01-01 RICHARD PALMIER

Plan id#	Filing Submission Date	Name of Administrator
001	2015-01-01	W. ROCKWELL WIRTZ
001	2014-01-01	W. ROCKWELL WIRTZ
001	2013-01-01	W. ROCKWELL WIRTZ
001	2012-01-01	W. ROCKWELL WIRTZ
001	2011-01-01	RICHARD PALMIER
001	2009-01-01	RICHARD PALMIER

Plan Statistics for WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN

401k plan membership statisitcs for WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN

Measure Date Value
2015: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 27
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 4
Total of all active and inactive participants 2015-01-01 32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 32
Number of participants with account balances 2015-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 18
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 11
Total of all active and inactive participants 2014-01-01 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 31
Number of participants with account balances 2014-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 19
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 10
Total of all active and inactive participants 2013-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 32
Number of participants with account balances 2013-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 16
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 25
Number of participants with account balances 2012-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 15
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 10
Total of all active and inactive participants 2011-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 25
Number of participants with account balances 2011-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 34
Number of other retired or separated participants entitled to future benefits 2009-01-01 7
Total of all active and inactive participants 2009-01-01 41
Total participants 2009-01-01 41
Number of participants with account balances 2009-01-01 37

Measure	Date	Value
2015: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	27
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	4
Total of all active and inactive participants	2015-01-01	32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	32
Number of participants with account balances	2015-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	18
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	11
Total of all active and inactive participants	2014-01-01	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	31
Number of participants with account balances	2014-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	19
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	10
Total of all active and inactive participants	2013-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	32
Number of participants with account balances	2013-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	16
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	25
Number of participants with account balances	2012-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	15
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	10
Total of all active and inactive participants	2011-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	25
Number of participants with account balances	2011-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	34
Number of other retired or separated participants entitled to future benefits	2009-01-01	7
Total of all active and inactive participants	2009-01-01	41
Total participants	2009-01-01	41
Number of participants with account balances	2009-01-01	37

Financial Data on WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN

Measure	Date	Value
2015 : WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$161,953
Expenses. Total of all expenses incurred	2015-12-31	$126,931
Benefits paid (including direct rollovers)	2015-12-31	$126,146
Total plan assets at end of year	2015-12-31	$2,366,270
Total plan assets at beginning of year	2015-12-31	$2,331,248
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$78,752
Expenses. Other expenses not covered elsewhere	2015-12-31	$785
Other income received	2015-12-31	$45,831
Net income (gross income less expenses)	2015-12-31	$35,022
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,366,270
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$2,331,248
Assets. Value of participant loans	2015-12-31	$37,654
Total contributions received or receivable from employer(s)	2015-12-31	$37,370
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$314,002
Expenses. Total of all expenses incurred	2014-12-31	$363,119
Benefits paid (including direct rollovers)	2014-12-31	$362,424
Total plan assets at end of year	2014-12-31	$2,331,248
Total plan assets at beginning of year	2014-12-31	$2,380,365
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$82,627
Expenses. Other expenses not covered elsewhere	2014-12-31	$695
Contributions received from other sources (not participants or employers)	2014-12-31	$117,481
Other income received	2014-12-31	$73,039
Net income (gross income less expenses)	2014-12-31	$-49,117
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,331,248
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,380,365
Assets. Value of participant loans	2014-12-31	$13,146
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2014-12-31	$384
Total contributions received or receivable from employer(s)	2014-12-31	$40,855
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$356,301
Expenses. Total of all expenses incurred	2013-12-31	$43,990
Benefits paid (including direct rollovers)	2013-12-31	$43,800
Total plan assets at end of year	2013-12-31	$2,380,365
Total plan assets at beginning of year	2013-12-31	$2,068,054
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$112,397
Other income received	2013-12-31	$147,125
Net income (gross income less expenses)	2013-12-31	$312,311
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,380,365
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,068,054
Assets. Value of participant loans	2013-12-31	$2,713
Total contributions received or receivable from employer(s)	2013-12-31	$96,779
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$190
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$243,766
Expenses. Total of all expenses incurred	2012-12-31	$80,404
Benefits paid (including direct rollovers)	2012-12-31	$80,304
Total plan assets at end of year	2012-12-31	$2,068,054
Total plan assets at beginning of year	2012-12-31	$1,904,692
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$107,630
Expenses. Other expenses not covered elsewhere	2012-12-31	$100
Other income received	2012-12-31	$130,587
Net income (gross income less expenses)	2012-12-31	$163,362
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,068,054
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,904,692
Assets. Value of participant loans	2012-12-31	$12,964
Total contributions received or receivable from employer(s)	2012-12-31	$5,549
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$-1,021,651
Total income from all sources	2011-12-31	$245,869
Expenses. Total of all expenses incurred	2011-12-31	$40,851
Benefits paid (including direct rollovers)	2011-12-31	$40,801
Total plan assets at end of year	2011-12-31	$1,904,692
Total plan assets at beginning of year	2011-12-31	$2,721,325
Value of fidelity bond covering the plan	2011-12-31	$250,000
Total contributions received or receivable from participants	2011-12-31	$135,834
Other income received	2011-12-31	$68,158
Net income (gross income less expenses)	2011-12-31	$205,018
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,904,692
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,721,325
Assets. Value of participant loans	2011-12-31	$7,044
Total contributions received or receivable from employer(s)	2011-12-31	$41,877
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$50
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$95,502
Total income from all sources	2010-12-31	$448,244
Expenses. Total of all expenses incurred	2010-12-31	$145,146
Benefits paid (including direct rollovers)	2010-12-31	$145,006
Total plan assets at end of year	2010-12-31	$2,721,325
Total plan assets at beginning of year	2010-12-31	$2,322,725
Value of fidelity bond covering the plan	2010-12-31	$250,000
Total contributions received or receivable from participants	2010-12-31	$181,394
Contributions received from other sources (not participants or employers)	2010-12-31	$95,502
Other income received	2010-12-31	$119,858
Net income (gross income less expenses)	2010-12-31	$303,098
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,721,325
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,322,725
Assets. Value of participant loans	2010-12-31	$10,228
Total contributions received or receivable from employer(s)	2010-12-31	$51,490
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$140
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN

2015: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: WIRTZ BEVERAGE ILLINOIS BELLEVILLE LLC 401K PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 52209-8

Policy instance

Insurance contract or identification number	RM 52209-8
Number of Individuals Covered	27
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,937
Total amount of fees paid to insurance company	USD $129
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,937
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	WILLIAM DAVIE / WIRTZ INSURANCE AGY

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 52209-8

Policy instance

Insurance contract or identification number	RM 52209-8
Number of Individuals Covered	30
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHU466

Policy instance

Insurance contract or identification number	PHU466
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,914
Total amount of fees paid to insurance company	USD $801
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,914
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	BENEFIT SERVICES GROUP, INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 52209-8

Policy instance

Insurance contract or identification number	RM 52209-8
Number of Individuals Covered	32
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $22
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	THOMAS PARKER

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHU466

Policy instance

Insurance contract or identification number	PHU466
Number of Individuals Covered	27
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,163
Total amount of fees paid to insurance company	USD $981
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,163
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	BENEFIT SERVICES GROUP, INC.

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHU466

Policy instance

Insurance contract or identification number	PHU466
Number of Individuals Covered	47
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,706
Total amount of fees paid to insurance company	USD $1,142
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHU466

Policy instance

Insurance contract or identification number	PHU466
Number of Individuals Covered	44
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,601
Total amount of fees paid to insurance company	USD $1,192
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,601
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	1192
Insurance broker name	BENEFIT SERVICES GROUP, INC.

Potentially related plans

WIRTZ BEVERAGE GROUP MN BEER UNION EMPLOYEES - LOCAL 792 401(K) PROFIT SHARING PLAN [EIN = 361976810]

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Company Name:	WIRTZ BEVERAGE ILLINOIS BELLEVILLE
Employer identification number (EIN):	370634183
NAIC Classification:	424800