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LABORERS LOCAL 996 HEALTH & WELFARE FUND 401k Plan overview

Plan NameLABORERS LOCAL 996 HEALTH & WELFARE FUND
Plan identification number 501

LABORERS LOCAL 996 HEALTH & WELFARE FUND Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

BOARD OF TRUSTEES OF LABORERS LOCAL 996 WELFARE FUND has sponsored the creation of one or more 401k plans.

Company Name:BOARD OF TRUSTEES OF LABORERS LOCAL 996 WELFARE FUND
Employer identification number (EIN):371337438
NAIC Classification:237990
NAIC Description:Other Heavy and Civil Engineering Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LABORERS LOCAL 996 HEALTH & WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-01-01
5012016-01-01BILL BOLLIGER2017-08-21
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01TRAVIS D SCHMID
5012011-01-01TRAVIS D SCHMID
5012009-01-01TRAVIS SCHMID

Plan Statistics for LABORERS LOCAL 996 HEALTH & WELFARE FUND

401k plan membership statisitcs for LABORERS LOCAL 996 HEALTH & WELFARE FUND

Measure Date Value
2016: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2016 401k membership
Total participants, beginning-of-year2016-01-0170
Total number of active participants reported on line 7a of the Form 55002016-01-010
Total of all active and inactive participants2016-01-010
2015: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2015 401k membership
Total participants, beginning-of-year2015-01-0170
Total number of active participants reported on line 7a of the Form 55002015-01-0170
Total of all active and inactive participants2015-01-0170
2014: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2014 401k membership
Total participants, beginning-of-year2014-01-0170
Total number of active participants reported on line 7a of the Form 55002014-01-0170
Total of all active and inactive participants2014-01-0170
2013: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2013 401k membership
Total participants, beginning-of-year2013-01-0168
Total number of active participants reported on line 7a of the Form 55002013-01-0170
Total of all active and inactive participants2013-01-0170
2012: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2012 401k membership
Total participants, beginning-of-year2012-01-0157
Total number of active participants reported on line 7a of the Form 55002012-01-0168
Total of all active and inactive participants2012-01-0168
2011: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2011 401k membership
Total participants, beginning-of-year2011-01-0148
Total number of active participants reported on line 7a of the Form 55002011-01-0157
Total of all active and inactive participants2011-01-0157
2009: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2009 401k membership
Total participants, beginning-of-year2009-01-01113
Total number of active participants reported on line 7a of the Form 55002009-01-0190
Total of all active and inactive participants2009-01-0190

Financial Data on LABORERS LOCAL 996 HEALTH & WELFARE FUND

Measure Date Value
2016 : LABORERS LOCAL 996 HEALTH & WELFARE FUND 2016 401k financial data
Expenses. Total of all expenses incurred2016-12-31$95,108
Benefits paid (including direct rollovers)2016-12-31$81,180
Total plan assets at end of year2016-12-31$0
Total plan assets at beginning of year2016-12-31$95,108
Value of fidelity bond covering the plan2016-12-31$250,000
Expenses. Other expenses not covered elsewhere2016-12-31$6,219
Net income (gross income less expenses)2016-12-31$-95,108
Net plan assets at end of year (total assets less liabilities)2016-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$95,108
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$7,709
2015 : LABORERS LOCAL 996 HEALTH & WELFARE FUND 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$541,374
Expenses. Total of all expenses incurred2015-12-31$-343,776
Benefits paid (including direct rollovers)2015-12-31$-355,516
Total plan assets at end of year2015-12-31$95,108
Total plan assets at beginning of year2015-12-31$292,706
Value of fidelity bond covering the plan2015-12-31$250,000
Expenses. Other expenses not covered elsewhere2015-12-31$4,625
Net income (gross income less expenses)2015-12-31$343,776
Net plan assets at end of year (total assets less liabilities)2015-12-31$95,108
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$-248,668
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$7,115
2014 : LABORERS LOCAL 996 HEALTH & WELFARE FUND 2014 401k financial data
Total plan liabilities at end of year2014-12-31$541,374
Total plan liabilities at beginning of year2014-12-31$81,490
Total income from all sources2014-12-31$0
Expenses. Total of all expenses incurred2014-12-31$993,882
Benefits paid (including direct rollovers)2014-12-31$938,227
Total plan assets at end of year2014-12-31$292,706
Total plan assets at beginning of year2014-12-31$826,704
Value of fidelity bond covering the plan2014-12-31$250,000
Total contributions received or receivable from participants2014-12-31$0
Expenses. Other expenses not covered elsewhere2014-12-31$14,421
Other income received2014-12-31$0
Net income (gross income less expenses)2014-12-31$-993,882
Net plan assets at end of year (total assets less liabilities)2014-12-31$-248,668
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$745,214
Total contributions received or receivable from employer(s)2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$41,234
2013 : LABORERS LOCAL 996 HEALTH & WELFARE FUND 2013 401k financial data
Total plan liabilities at end of year2013-12-31$81,490
Total plan liabilities at beginning of year2013-12-31$83,090
Total income from all sources2013-12-31$121,130
Expenses. Total of all expenses incurred2013-12-31$667,184
Benefits paid (including direct rollovers)2013-12-31$611,777
Total plan assets at end of year2013-12-31$826,704
Total plan assets at beginning of year2013-12-31$1,374,358
Value of fidelity bond covering the plan2013-12-31$250,000
Total contributions received or receivable from participants2013-12-31$2,924
Expenses. Other expenses not covered elsewhere2013-12-31$2,930
Other income received2013-12-31$2,135
Net income (gross income less expenses)2013-12-31$-546,054
Net plan assets at end of year (total assets less liabilities)2013-12-31$745,214
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,291,268
Total contributions received or receivable from employer(s)2013-12-31$116,071
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$52,477
2012 : LABORERS LOCAL 996 HEALTH & WELFARE FUND 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$83,090
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$19,928
Total income from all sources (including contributions)2012-12-31$139,147
Total of all expenses incurred2012-12-31$554,247
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$503,967
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$135,406
Value of total assets at end of year2012-12-31$1,374,358
Value of total assets at beginning of year2012-12-31$1,726,296
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$50,280
Total interest from all sources2012-12-31$3,741
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$18,389
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$250,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$3,430
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$3,549
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$2,862
Administrative expenses (other) incurred2012-12-31$3,621
Liabilities. Value of operating payables at end of year2012-12-31$667
Liabilities. Value of operating payables at beginning of year2012-12-31$2,532
Total non interest bearing cash at end of year2012-12-31$216,524
Total non interest bearing cash at beginning of year2012-12-31$173,180
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-415,100
Value of net assets at end of year (total assets less liabilities)2012-12-31$1,291,268
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$1,706,368
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$1,144,966
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$1,547,625
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$1,547,625
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$3,741
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$136,330
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$131,976
Employer contributions (assets) at end of year2012-12-31$9,319
Employer contributions (assets) at beginning of year2012-12-31$2,629
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$367,637
Contract administrator fees2012-12-31$28,270
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at end of year2012-12-31$82,423
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$17,396
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31ROMOLO & ASSOCIATES, CPA'S
Accountancy firm EIN2012-12-31371077733
2011 : LABORERS LOCAL 996 HEALTH & WELFARE FUND 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$19,928
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$9,529
Total income from all sources (including contributions)2011-12-31$124,061
Total of all expenses incurred2011-12-31$393,198
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$335,824
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$116,245
Value of total assets at end of year2011-12-31$1,726,296
Value of total assets at beginning of year2011-12-31$1,985,034
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$57,374
Total interest from all sources2011-12-31$7,816
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$20,000
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$200,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$614
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$2,862
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$5,468
Administrative expenses (other) incurred2011-12-31$4,674
Liabilities. Value of operating payables at end of year2011-12-31$2,532
Liabilities. Value of operating payables at beginning of year2011-12-31$821
Total non interest bearing cash at end of year2011-12-31$173,180
Total non interest bearing cash at beginning of year2011-12-31$434,419
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-269,137
Value of net assets at end of year (total assets less liabilities)2011-12-31$1,706,368
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$1,975,505
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$1,547,625
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,537,957
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$1,537,957
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$7,816
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$156,254
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$115,631
Employer contributions (assets) at end of year2011-12-31$2,629
Employer contributions (assets) at beginning of year2011-12-31$7,190
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$179,570
Contract administrator fees2011-12-31$32,700
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$17,396
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$8,708
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31ROMOLO & ASSOCIATES, CPA'S
Accountancy firm EIN2011-12-31371077733
2010 : LABORERS LOCAL 996 HEALTH & WELFARE FUND 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$9,529
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$20,361
Total income from all sources (including contributions)2010-12-31$323,459
Total of all expenses incurred2010-12-31$303,430
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$259,363
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$309,466
Value of total assets at end of year2010-12-31$1,985,034
Value of total assets at beginning of year2010-12-31$1,975,837
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$44,067
Total interest from all sources2010-12-31$13,993
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$18,325
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$200,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$4,106
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$5,468
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$19,501
Administrative expenses (other) incurred2010-12-31$3,732
Liabilities. Value of operating payables at end of year2010-12-31$821
Liabilities. Value of operating payables at beginning of year2010-12-31$719
Total non interest bearing cash at end of year2010-12-31$434,419
Total non interest bearing cash at beginning of year2010-12-31$399,404
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$20,029
Value of net assets at end of year (total assets less liabilities)2010-12-31$1,975,505
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$1,955,476
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$1,537,957
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$1,520,062
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$1,520,062
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$13,993
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$81,305
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$305,360
Employer contributions (assets) at end of year2010-12-31$7,190
Employer contributions (assets) at beginning of year2010-12-31$36,870
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$178,058
Contract administrator fees2010-12-31$22,010
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$8,708
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$19,642
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31ROMOLO & ASSOCIATES, CPA'S
Accountancy firm EIN2010-12-31371077733

Form 5500 Responses for LABORERS LOCAL 996 HEALTH & WELFARE FUND

2016: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedYes
2016-01-01This submission is the final filingYes
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: LABORERS LOCAL 996 HEALTH & WELFARE FUND 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 )
Policy contract numberSSL-ILCRS-00489
Policy instance 1
Insurance contract or identification numberSSL-ILCRS-00489
Number of Individuals Covered17
Insurance policy start date2015-01-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $29,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 )
Policy contract numberSSL-ILCRS-00489
Policy instance 1
Insurance contract or identification numberSSL-ILCRS-00489
Number of Individuals Covered70
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $156,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract number98229
Policy instance 1
Insurance contract or identification number98229
Number of Individuals Covered70
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $168,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFI7
Policy instance 2
Insurance contract or identification numberG000AFI7
Number of Individuals Covered70
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $311
Total amount of fees paid to insurance companyUSD $101
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $311
Amount paid for insurance broker fees101
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameDANSIG INCORPORATED
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract number98229
Policy instance 1
Insurance contract or identification number98229
Number of Individuals Covered68
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $17,889
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $136,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,889
Insurance broker nameGREG GALLO
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFI7
Policy instance 2
Insurance contract or identification numberG000AFI7
Number of Individuals Covered69
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $350
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $350
Insurance broker organization code?3
Insurance broker nameDANSIG INCORPORATED
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract number98229
Policy instance 1
Insurance contract or identification number98229
Number of Individuals Covered67
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $16,829
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $152,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFI7
Policy instance 2
Insurance contract or identification numberG000AFI7
Number of Individuals Covered67
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $317
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract number98229
Policy instance 1
Insurance contract or identification number98229
Number of Individuals Covered50
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $82,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFI7
Policy instance 2
Insurance contract or identification numberG000AFI7
Number of Individuals Covered38
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $207
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $207
Insurance broker organization code?3
Insurance broker nameDANSIG INCORPORATED

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