WARREN INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC.
401k plan membership statisitcs for WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC.
| Measure | Date | Value |
|---|
| 2018 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $125,120 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $109,548 |
| Total income from all sources (including contributions) | 2018-05-31 | $1,479,152 |
| Total of all expenses incurred | 2018-05-31 | $1,554,712 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-05-31 | $1,439,385 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-05-31 | $1,479,152 |
| Value of total assets at end of year | 2018-05-31 | $0 |
| Value of total assets at beginning of year | 2018-05-31 | $59,988 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-05-31 | $115,327 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-05-31 | No |
| Administrative expenses professional fees incurred | 2018-05-31 | $104,451 |
| Was this plan covered by a fidelity bond | 2018-05-31 | Yes |
| Value of fidelity bond cover | 2018-05-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-05-31 | No |
| Contributions received from participants | 2018-05-31 | $325,036 |
| Total non interest bearing cash at end of year | 2018-05-31 | $0 |
| Total non interest bearing cash at beginning of year | 2018-05-31 | $59,988 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Value of net income/loss | 2018-05-31 | $-75,560 |
| Value of net assets at end of year (total assets less liabilities) | 2018-05-31 | $-125,120 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-05-31 | $-49,560 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-05-31 | $179,027 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-05-31 | No |
| Contributions received in cash from employer | 2018-05-31 | $1,154,116 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-05-31 | $1,260,358 |
| Contract administrator fees | 2018-05-31 | $10,876 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-05-31 | $125,120 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-05-31 | $109,548 |
| Did the plan have assets held for investment | 2018-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-05-31 | Unqualified |
| Accountancy firm name | 2018-05-31 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2018-05-31 | 410746749 |
| 2017 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $109,548 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $157,949 |
| Total income from all sources (including contributions) | 2017-05-31 | $1,351,116 |
| Total of all expenses incurred | 2017-05-31 | $1,307,229 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-05-31 | $1,208,360 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-05-31 | $1,351,116 |
| Value of total assets at end of year | 2017-05-31 | $59,988 |
| Value of total assets at beginning of year | 2017-05-31 | $64,502 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-05-31 | $98,869 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-05-31 | No |
| Administrative expenses professional fees incurred | 2017-05-31 | $87,074 |
| Was this plan covered by a fidelity bond | 2017-05-31 | Yes |
| Value of fidelity bond cover | 2017-05-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-05-31 | No |
| Contributions received from participants | 2017-05-31 | $326,834 |
| Total non interest bearing cash at end of year | 2017-05-31 | $59,988 |
| Total non interest bearing cash at beginning of year | 2017-05-31 | $64,502 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Value of net income/loss | 2017-05-31 | $43,887 |
| Value of net assets at end of year (total assets less liabilities) | 2017-05-31 | $-49,560 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-05-31 | $-93,447 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-05-31 | $190,041 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-05-31 | No |
| Contributions received in cash from employer | 2017-05-31 | $1,024,282 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-05-31 | $1,018,319 |
| Contract administrator fees | 2017-05-31 | $11,795 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2017-05-31 | $109,548 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-05-31 | $157,949 |
| Did the plan have assets held for investment | 2017-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-05-31 | Unqualified |
| Accountancy firm name | 2017-05-31 | SCHENCK SC |
| Accountancy firm EIN | 2017-05-31 | 391173131 |
| 2016 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $157,949 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $102,062 |
| Total income from all sources (including contributions) | 2016-05-31 | $1,589,064 |
| Total of all expenses incurred | 2016-05-31 | $1,568,762 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-05-31 | $1,465,281 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-05-31 | $1,589,064 |
| Value of total assets at end of year | 2016-05-31 | $140,315 |
| Value of total assets at beginning of year | 2016-05-31 | $64,126 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-05-31 | $103,481 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-05-31 | No |
| Administrative expenses professional fees incurred | 2016-05-31 | $90,986 |
| Was this plan covered by a fidelity bond | 2016-05-31 | Yes |
| Value of fidelity bond cover | 2016-05-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-05-31 | No |
| Contributions received from participants | 2016-05-31 | $310,663 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-05-31 | $75,813 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-05-31 | $17,294 |
| Liabilities. Value of operating payables at end of year | 2016-05-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2016-05-31 | $3,035 |
| Total non interest bearing cash at end of year | 2016-05-31 | $64,502 |
| Total non interest bearing cash at beginning of year | 2016-05-31 | $46,832 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Value of net income/loss | 2016-05-31 | $20,302 |
| Value of net assets at end of year (total assets less liabilities) | 2016-05-31 | $-17,634 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-05-31 | $-37,936 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-05-31 | $181,660 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-05-31 | No |
| Contributions received in cash from employer | 2016-05-31 | $1,278,401 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-05-31 | $1,283,621 |
| Contract administrator fees | 2016-05-31 | $12,495 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-05-31 | $157,949 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-05-31 | $99,027 |
| Did the plan have assets held for investment | 2016-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-05-31 | Unqualified |
| Accountancy firm name | 2016-05-31 | SCHENCK SC |
| Accountancy firm EIN | 2016-05-31 | 391173131 |
| 2015 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $102,062 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $39,013 |
| Total income from all sources (including contributions) | 2015-05-31 | $1,069,593 |
| Total of all expenses incurred | 2015-05-31 | $1,134,610 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-05-31 | $1,042,060 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-05-31 | $1,069,593 |
| Value of total assets at end of year | 2015-05-31 | $64,126 |
| Value of total assets at beginning of year | 2015-05-31 | $66,094 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-05-31 | $92,550 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | No |
| Administrative expenses professional fees incurred | 2015-05-31 | $80,842 |
| Was this plan covered by a fidelity bond | 2015-05-31 | Yes |
| Value of fidelity bond cover | 2015-05-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
| Contributions received from participants | 2015-05-31 | $286,800 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-05-31 | $17,294 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-05-31 | $24,094 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-05-31 | $62 |
| Liabilities. Value of operating payables at end of year | 2015-05-31 | $3,035 |
| Liabilities. Value of operating payables at beginning of year | 2015-05-31 | $4,630 |
| Total non interest bearing cash at end of year | 2015-05-31 | $46,832 |
| Total non interest bearing cash at beginning of year | 2015-05-31 | $42,000 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Value of net income/loss | 2015-05-31 | $-65,017 |
| Value of net assets at end of year (total assets less liabilities) | 2015-05-31 | $-37,936 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-05-31 | $27,081 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-05-31 | $158,006 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
| Contributions received in cash from employer | 2015-05-31 | $782,793 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-05-31 | $884,054 |
| Contract administrator fees | 2015-05-31 | $11,708 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2015-05-31 | $99,027 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-05-31 | $34,321 |
| Did the plan have assets held for investment | 2015-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-05-31 | Unqualified |
| Accountancy firm name | 2015-05-31 | SCHENCK SC |
| Accountancy firm EIN | 2015-05-31 | 391173131 |
| 2014 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $39,013 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $41,528 |
| Total income from all sources (including contributions) | 2014-05-31 | $1,207,013 |
| Total of all expenses incurred | 2014-05-31 | $1,224,474 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-05-31 | $1,131,828 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-05-31 | $1,207,013 |
| Value of total assets at end of year | 2014-05-31 | $66,094 |
| Value of total assets at beginning of year | 2014-05-31 | $86,070 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-05-31 | $92,646 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-05-31 | No |
| Administrative expenses professional fees incurred | 2014-05-31 | $80,921 |
| Was this plan covered by a fidelity bond | 2014-05-31 | Yes |
| Value of fidelity bond cover | 2014-05-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-05-31 | No |
| Contributions received from participants | 2014-05-31 | $285,655 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-05-31 | $24,094 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-05-31 | $62 |
| Liabilities. Value of operating payables at end of year | 2014-05-31 | $4,630 |
| Total non interest bearing cash at end of year | 2014-05-31 | $42,000 |
| Total non interest bearing cash at beginning of year | 2014-05-31 | $86,070 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Value of net income/loss | 2014-05-31 | $-17,461 |
| Value of net assets at end of year (total assets less liabilities) | 2014-05-31 | $27,081 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-05-31 | $44,542 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-05-31 | $140,812 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-05-31 | No |
| Contributions received in cash from employer | 2014-05-31 | $921,358 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-05-31 | $991,016 |
| Contract administrator fees | 2014-05-31 | $11,725 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-05-31 | $34,321 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-05-31 | $41,528 |
| Did the plan have assets held for investment | 2014-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-05-31 | Unqualified |
| Accountancy firm name | 2014-05-31 | SCHENCK SC |
| Accountancy firm EIN | 2014-05-31 | 391173131 |
| 2013 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $41,528 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $108,102 |
| Total income from all sources (including contributions) | 2013-05-31 | $1,656,314 |
| Total of all expenses incurred | 2013-05-31 | $1,538,965 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-05-31 | $1,444,869 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-05-31 | $1,656,314 |
| Value of total assets at end of year | 2013-05-31 | $86,070 |
| Value of total assets at beginning of year | 2013-05-31 | $35,295 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-05-31 | $94,096 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-05-31 | No |
| Administrative expenses professional fees incurred | 2013-05-31 | $89,747 |
| Was this plan covered by a fidelity bond | 2013-05-31 | Yes |
| Value of fidelity bond cover | 2013-05-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-05-31 | No |
| Contributions received from participants | 2013-05-31 | $272,733 |
| Total non interest bearing cash at end of year | 2013-05-31 | $86,070 |
| Total non interest bearing cash at beginning of year | 2013-05-31 | $35,295 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Value of net income/loss | 2013-05-31 | $117,349 |
| Value of net assets at end of year (total assets less liabilities) | 2013-05-31 | $44,542 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-05-31 | $-72,807 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-05-31 | $150,939 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-05-31 | No |
| Contributions received in cash from employer | 2013-05-31 | $1,383,581 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-05-31 | $1,293,930 |
| Contract administrator fees | 2013-05-31 | $4,349 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-05-31 | $41,528 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-05-31 | $108,102 |
| Did the plan have assets held for investment | 2013-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-05-31 | Unqualified |
| Accountancy firm name | 2013-05-31 | BAKER TILLY VIRCHOW KRAUSE, LLP |
| Accountancy firm EIN | 2013-05-31 | 390859910 |
| 2012 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $108,102 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $60,165 |
| Total income from all sources (including contributions) | 2012-05-31 | $1,611,094 |
| Total of all expenses incurred | 2012-05-31 | $1,774,141 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-05-31 | $1,669,417 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-05-31 | $1,611,094 |
| Value of total assets at end of year | 2012-05-31 | $35,295 |
| Value of total assets at beginning of year | 2012-05-31 | $150,405 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-05-31 | $104,724 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-05-31 | No |
| Administrative expenses professional fees incurred | 2012-05-31 | $89,926 |
| Was this plan covered by a fidelity bond | 2012-05-31 | Yes |
| Value of fidelity bond cover | 2012-05-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-05-31 | No |
| Contributions received from participants | 2012-05-31 | $311,516 |
| Total non interest bearing cash at end of year | 2012-05-31 | $35,295 |
| Total non interest bearing cash at beginning of year | 2012-05-31 | $150,405 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Value of net income/loss | 2012-05-31 | $-163,047 |
| Value of net assets at end of year (total assets less liabilities) | 2012-05-31 | $-72,807 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-05-31 | $90,240 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-05-31 | $165,248 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-05-31 | No |
| Contributions received in cash from employer | 2012-05-31 | $1,299,578 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-05-31 | $1,504,169 |
| Contract administrator fees | 2012-05-31 | $14,798 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-05-31 | $108,102 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-05-31 | $60,165 |
| Did the plan have assets held for investment | 2012-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-05-31 | Unqualified |
| Accountancy firm name | 2012-05-31 | BAKER TILLY VIRCHOW KRAUSE, LLP |
| Accountancy firm EIN | 2012-05-31 | 390859910 |
| 2011 : WARREN INDUSTRIES VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION, INC. 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $60,165 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $138,619 |
| Total income from all sources (including contributions) | 2011-05-31 | $1,513,638 |
| Total of all expenses incurred | 2011-05-31 | $1,312,449 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-05-31 | $1,203,245 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-05-31 | $1,513,638 |
| Value of total assets at end of year | 2011-05-31 | $150,405 |
| Value of total assets at beginning of year | 2011-05-31 | $27,670 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-05-31 | $109,204 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-05-31 | No |
| Administrative expenses professional fees incurred | 2011-05-31 | $93,093 |
| Was this plan covered by a fidelity bond | 2011-05-31 | Yes |
| Value of fidelity bond cover | 2011-05-31 | $300,000 |
| If this is an individual account plan, was there a blackout period | 2011-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-05-31 | No |
| Contributions received from participants | 2011-05-31 | $333,712 |
| Total non interest bearing cash at end of year | 2011-05-31 | $150,405 |
| Total non interest bearing cash at beginning of year | 2011-05-31 | $27,670 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Value of net income/loss | 2011-05-31 | $201,189 |
| Value of net assets at end of year (total assets less liabilities) | 2011-05-31 | $90,240 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-05-31 | $-110,949 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-05-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-05-31 | $166,809 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-05-31 | No |
| Contributions received in cash from employer | 2011-05-31 | $1,179,926 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-05-31 | $1,036,436 |
| Contract administrator fees | 2011-05-31 | $16,111 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-05-31 | $60,165 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-05-31 | $138,619 |
| Did the plan have assets held for investment | 2011-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-05-31 | Unqualified |
| Accountancy firm name | 2011-05-31 | BAKER TILLY VIRCHOW KRAUSE, LLP |
| Accountancy firm EIN | 2011-05-31 | 390859910 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174 |
| Policy instance | 9 |
| Insurance contract or identification number | IISI 3174 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $6,743 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $161,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,743 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AV6Z |
| Policy instance | 7 |
| Insurance contract or identification number | GUPR0AV6Z | | Number of Individuals Covered | 66 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $2,091 | | Total amount of fees paid to insurance company | USD $393 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $13,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,091 | | Amount paid for insurance broker fees | 393 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AV6Z |
| Policy instance | 8 |
| Insurance contract or identification number | GVTL0AV6Z | | Number of Individuals Covered | 108 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $5,748 | | Total amount of fees paid to insurance company | USD $2,816 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&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 Carrier | USD $45,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,748 | | Amount paid for insurance broker fees | 2816 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AV6Z |
| Policy instance | 6 |
| Insurance contract or identification number | GLTD0AV6Z | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $628 | | Total amount of fees paid to insurance company | USD $445 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $4,170 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $628 | | Amount paid for insurance broker fees | 445 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AV6Z |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 0AV6Z | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $524 | | Total amount of fees paid to insurance company | USD $559 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $5,216 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $524 | | Amount paid for insurance broker fees | 559 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AV6Z |
| Policy instance | 5 |
| Insurance contract or identification number | GUC 0AV6Z | | Number of Individuals Covered | 106 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $2,575 | | Total amount of fees paid to insurance company | USD $1,213 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $25,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,575 | | Amount paid for insurance broker fees | 1213 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AV6Z |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AV6Z | | Number of Individuals Covered | 208 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $1,240 | | Total amount of fees paid to insurance company | USD $1,020 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&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 Carrier | USD $10,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,240 | | Amount paid for insurance broker fees | 1020 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 220341 |
| Policy instance | 2 |
| Insurance contract or identification number | 220341 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $354 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | 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 | | Other welfare benefits provided | LONG TERM CARE | | 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 Carrier | USD $2,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $354 | | Insurance broker organization code? | 3 |
|
| SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 ) |
| Policy contract number | 33245 |
| Policy instance | 1 |
| Insurance contract or identification number | 33245 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $688 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $6,879 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $688 | | Insurance broker organization code? | 3 |
|
| SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 ) |
| Policy contract number | 33245 |
| Policy instance | 1 |
| Insurance contract or identification number | 33245 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $906 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $906 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 220341 |
| Policy instance | 2 |
| Insurance contract or identification number | 220341 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $383 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $2,752 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $383 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AV6Z |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AV6Z | | Number of Individuals Covered | 121 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,707 | | Total amount of fees paid to insurance company | USD $990 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $17,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,707 | | Amount paid for insurance broker fees | 990 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AV6Z |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 0AV6Z | | Number of Individuals Covered | 42 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,049 | | Total amount of fees paid to insurance company | USD $606 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,049 | | Amount paid for insurance broker fees | 606 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AV6Z |
| Policy instance | 5 |
| Insurance contract or identification number | GUC 0AV6Z | | Number of Individuals Covered | 48 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $2,195 | | Total amount of fees paid to insurance company | USD $1,225 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,195 | | Amount paid for insurance broker fees | 1225 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AV6Z |
| Policy instance | 6 |
| Insurance contract or identification number | GLTD0AV6Z | | Number of Individuals Covered | 42 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,252 | | Total amount of fees paid to insurance company | USD $482 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,252 | | Amount paid for insurance broker fees | 482 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AV6Z |
| Policy instance | 7 |
| Insurance contract or identification number | GUPR0AV6Z | | Number of Individuals Covered | 20 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,123 | | Total amount of fees paid to insurance company | USD $431 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,489 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,123 | | Amount paid for insurance broker fees | 431 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AV6Z |
| Policy instance | 8 |
| Insurance contract or identification number | GVTL0AV6Z | | Number of Individuals Covered | 67 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $6,116 | | Total amount of fees paid to insurance company | USD $2,822 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $49,560 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,116 | | Amount paid for insurance broker fees | 2822 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174 |
| Policy instance | 9 |
| Insurance contract or identification number | IISI 3174 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $6,816 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $163,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,816 |
|
| SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 ) |
| Policy contract number | 33245 |
| Policy instance | 1 |
| Insurance contract or identification number | 33245 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $758 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,578 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174 |
| Policy instance | 9 |
| Insurance contract or identification number | IISI 3174 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $7,111 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $170,673 | | 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 number | GVTL0AV6Z |
| Policy instance | 8 |
| Insurance contract or identification number | GVTL0AV6Z | | Number of Individuals Covered | 91 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $6,411 | | Total amount of fees paid to insurance company | USD $3,243 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $53,171 | | 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 number | GUPR0AV6Z |
| Policy instance | 7 |
| Insurance contract or identification number | GUPR0AV6Z | | Number of Individuals Covered | 24 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $1,198 | | Total amount of fees paid to insurance company | USD $520 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,989 | | 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 number | GLTD0AV6Z |
| Policy instance | 6 |
| Insurance contract or identification number | GLTD0AV6Z | | Number of Individuals Covered | 54 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $1,232 | | Total amount of fees paid to insurance company | USD $443 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,212 | | 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 number | GUC 0AV6Z |
| Policy instance | 5 |
| Insurance contract or identification number | GUC 0AV6Z | | Number of Individuals Covered | 58 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $2,171 | | Total amount of fees paid to insurance company | USD $1,333 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,711 | | 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 number | GLUG0AV6Z |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AV6Z | | Number of Individuals Covered | 156 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $1,714 | | Total amount of fees paid to insurance company | USD $947 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $17,141 | | 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 number | GUG 0AV6Z |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 0AV6Z | | Number of Individuals Covered | 54 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $1,037 | | Total amount of fees paid to insurance company | USD $559 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,373 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 220341 |
| Policy instance | 2 |
| Insurance contract or identification number | 220341 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $324 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $1,966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174 |
| Policy instance | 9 |
| Insurance contract or identification number | IISI 3174 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $7,209 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $173,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,209 | | Insurance broker name | HAYS COMPANIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AV6Z |
| Policy instance | 8 |
| Insurance contract or identification number | GVTL0AV6Z | | Number of Individuals Covered | 118 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $6,768 | | Total amount of fees paid to insurance company | USD $1,836 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $55,674 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,768 | | Amount paid for insurance broker fees | 1836 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AV6Z |
| Policy instance | 7 |
| Insurance contract or identification number | GUPR0AV6Z | | Number of Individuals Covered | 39 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $1,646 | | Total amount of fees paid to insurance company | USD $424 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,646 | | Amount paid for insurance broker fees | 424 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AV6Z |
| Policy instance | 6 |
| Insurance contract or identification number | GLTD0AV6Z | | Number of Individuals Covered | 44 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $974 | | Total amount of fees paid to insurance company | USD $189 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $974 | | Amount paid for insurance broker fees | 189 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AV6Z |
| Policy instance | 5 |
| Insurance contract or identification number | GUC 0AV6Z | | Number of Individuals Covered | 76 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $2,744 | | Total amount of fees paid to insurance company | USD $835 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,744 | | Amount paid for insurance broker fees | 835 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AV6Z |
| Policy instance | 4 |
| Insurance contract or identification number | GUG 0AV6Z | | Number of Individuals Covered | 44 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $816 | | Total amount of fees paid to insurance company | USD $238 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $816 | | Amount paid for insurance broker fees | 238 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AV6Z |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AV6Z | | Number of Individuals Covered | 172 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $1,480 | | Total amount of fees paid to insurance company | USD $433 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $14,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,480 | | Amount paid for insurance broker fees | 433 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 220341 |
| Policy instance | 2 |
| Insurance contract or identification number | 220341 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $456 | | Total amount of fees paid to insurance company | USD $30 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $3,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $456 | | Amount paid for insurance broker fees | 30 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS BENEFITS GROUP LLC |
|
| SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 ) |
| Policy contract number | 033245 |
| Policy instance | 1 |
| Insurance contract or identification number | 033245 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $989 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $989 | | Insurance broker name | HAYS COMPANIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AV6Z |
| Policy instance | 10 |
| Insurance contract or identification number | GLUG0AV6Z | | Number of Individuals Covered | 155 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $597 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $5,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $597 | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 220341 |
| Policy instance | 9 |
| Insurance contract or identification number | 220341 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $295 | | Total amount of fees paid to insurance company | USD $4 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $1,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $268 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker name | HAYS BENEFITS GROUP LLC |
|
| SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 ) |
| Policy contract number | 033245 |
| Policy instance | 8 |
| Insurance contract or identification number | 033245 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $312 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,119 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $312 | | Insurance broker name | HAYS COMPANIES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158978 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010158978 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,208 | | Total amount of fees paid to insurance company | USD $537 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,669 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $674 | | Amount paid for insurance broker fees | 537 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS COMPANIES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400158101 |
| Policy instance | 6 |
| Insurance contract or identification number | 000400158101 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,911 | | Total amount of fees paid to insurance company | USD $1,139 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $26,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,963 | | Amount paid for insurance broker fees | 1139 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS COMPANIES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158102 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010158102 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $638 | | Total amount of fees paid to insurance company | USD $210 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $343 | | Amount paid for insurance broker fees | 210 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS COMPANIES |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174 |
| Policy instance | 3 |
| Insurance contract or identification number | IISI 3174 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $7,417 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $148,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,390 | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158980 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010158980 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,233 | | Total amount of fees paid to insurance company | USD $328 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $607 | | Amount paid for insurance broker fees | 328 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS COMPANIES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158099 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010158099 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,003 | | Total amount of fees paid to insurance company | USD $371 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $8,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $529 | | Amount paid for insurance broker fees | 371 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS COMPANIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0AV6Z |
| Policy instance | 11 |
| Insurance contract or identification number | GUG 0AV6Z | | Number of Individuals Covered | 43 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $331 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $331 | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AV6Z |
| Policy instance | 13 |
| Insurance contract or identification number | GLTD0AV6Z | | Number of Individuals Covered | 43 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $395 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $395 | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158100 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010158100 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $596 | | Total amount of fees paid to insurance company | USD $161 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $300 | | Amount paid for insurance broker fees | 161 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | HAYS COMPANIES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AV6Z |
| Policy instance | 15 |
| Insurance contract or identification number | GVTL0AV6Z | | Number of Individuals Covered | 111 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $3,381 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $22,542 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,381 | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AV6Z |
| Policy instance | 14 |
| Insurance contract or identification number | GUPR0AV6Z | | Number of Individuals Covered | 36 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $656 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $656 | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AV6Z |
| Policy instance | 12 |
| Insurance contract or identification number | GUC 0AV6Z | | Number of Individuals Covered | 68 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,102 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,102 | | Insurance broker organization code? | 3 | | Insurance broker name | THE HAYS BENEFITS GROUP OF WI LLC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400158101 |
| Policy instance | 6 |
| Insurance contract or identification number | 000400158101 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $8,537 | | Total amount of fees paid to insurance company | USD $2,710 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $56,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,537 | | Amount paid for insurance broker fees | 2710 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158099 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010158099 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $1,823 | | Total amount of fees paid to insurance company | USD $971 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $18,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,823 | | Amount paid for insurance broker fees | 971 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158980 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010158980 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $2,473 | | Total amount of fees paid to insurance company | USD $886 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,111 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,473 | | Amount paid for insurance broker fees | 886 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158100 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010158100 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $1,205 | | Total amount of fees paid to insurance company | USD $424 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,205 | | Amount paid for insurance broker fees | 424 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158978 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010158978 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $2,284 | | Total amount of fees paid to insurance company | USD $1,359 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,284 | | Amount paid for insurance broker fees | 1359 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158102 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010158102 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $1,241 | | Total amount of fees paid to insurance company | USD $548 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,241 | | Amount paid for insurance broker fees | 548 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174-13 |
| Policy instance | 7 |
| Insurance contract or identification number | IISI 3174-13 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,281 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $129,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,281 | | Insurance broker organization code? | 3 | | Insurance broker name | R AND R INS SVCS INC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158102 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010158102 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $1,289 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,042 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,289 | | Insurance broker organization code? | 3 | | Insurance broker name | R&R INSURANCE |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158980 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010158980 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $2,381 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,521 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,381 | | Insurance broker organization code? | 3 | | Insurance broker name | R&R INSURANCE |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158099 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010158099 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $1,905 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $19,347 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,905 | | Insurance broker organization code? | 3 | | Insurance broker name | R&R INSURANCE SERVICES, INC. |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174-12 |
| Policy instance | 3 |
| Insurance contract or identification number | IISI 3174-12 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,255 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $143,871 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,755 | | Insurance broker organization code? | 3 | | Insurance broker name | R&R INSURANCE |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010158100 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010158100 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $1,276 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,508 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,276 | | Insurance broker organization code? | 3 | | Insurance broker name | R&R INSURANCE |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000400158101 |
| Policy instance | 5 |
| Insurance contract or identification number | 000400158101 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $8,264 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $55,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,264 | | Insurance broker organization code? | 3 | | Insurance broker name | R&R INSURANCE |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | IISI 3174 |
| Policy instance | 3 |
| Insurance contract or identification number | IISI 3174 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $171,459 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5283724 |
| Policy instance | 2 |
| Insurance contract or identification number | 5283724 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $10,683 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $100,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5278147 |
| Policy instance | 1 |
| Insurance contract or identification number | 5278147 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,859 | | Total amount of fees paid to insurance company | USD $1,139 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $38,556 | | 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 number | 203560 |
| Policy instance | 3 |
| Insurance contract or identification number | 203560 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,346 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $154,929 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5283724 |
| Policy instance | 2 |
| Insurance contract or identification number | 5283724 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $10,902 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $102,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5278147 |
| Policy instance | 1 |
| Insurance contract or identification number | 5278147 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,635 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $35,926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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