401k Plan data: CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN plan

CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN 401k Plan overview

Plan Name	CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN
Plan identification number	506

CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

TRIVIUM LIFE SERVICES has sponsored the creation of one or more 401k plans.

Company Name: TRIVIUM LIFE SERVICES

Employer identification number (EIN): 421041046

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2014-07-01
506 2014-07-01 RENEE ERBES
506 2013-07-01
506 2013-07-01 RENEE ERBES

Form 5500 Responses for CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN

2014: CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	Yes
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: CROSSROADS OF WESTERN IOWA DISABILITY BENEFITS SECOND PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	First time form 5500 has been submitted	Yes
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1036453

Policy instance

Insurance contract or identification number	1036453
Number of Individuals Covered	185
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $8,695
Total amount of fees paid to insurance company	USD $0
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	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 $57,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1036453

Policy instance

Insurance contract or identification number	1036453
Number of Individuals Covered	153
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $7,009
Total amount of fees paid to insurance company	USD $2,231
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	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 $46,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TRIVIUM LIFE SERVICES
Employer identification number (EIN):	421041046
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Plan id#	Filing Submission Date	Name of Administrator
506	2014-07-01
506	2014-07-01	RENEE ERBES
506	2013-07-01
506	2013-07-01	RENEE ERBES