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CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 401k Plan overview

Plan NameCABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN
Plan identification number 002

CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • ESOP other than a leveraged ESOP - A completed Schedule E must be attached to a Form 5500 filed for an Employee Stock Ownership Plan (ESOP).
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan requiring that all or part of employer contributions be invested and held, at least for a limited period, in employer securities.

401k Sponsoring company profile

CABOOL STATE BANK has sponsored the creation of one or more 401k plans.

Company Name:CABOOL STATE BANK
Employer identification number (EIN):440189180
NAIC Classification:522110
NAIC Description:Commercial Banking

Additional information about CABOOL STATE BANK

Jurisdiction of Incorporation: Missouri Secretary of State
Incorporation Date:
Company Identification Number: K00001916

More information about CABOOL STATE BANK

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022016-01-01ROGER LINDSEY
0022015-01-01ROGER LINDSEY
0022014-01-01ROGER LINDSEY ROGER LINDSEY2015-07-17
0022013-01-01ROGER LINDSEY
0022012-01-01ROGER LINDSEY
0022011-01-01ROGER LINDSEY
0022009-01-01ROGER LINDSEY

Plan Statistics for CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN

401k plan membership statisitcs for CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN

Measure Date Value
2016: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0127
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-010
Number of participants with account balances2016-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0127
Total number of active participants reported on line 7a of the Form 55002015-01-0126
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-011
Total of all active and inactive participants2015-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0127
Number of participants with account balances2015-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0126
Total number of active participants reported on line 7a of the Form 55002014-01-0123
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0124
Number of participants with account balances2014-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0127
Total number of active participants reported on line 7a of the Form 55002013-01-0124
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0125
Number of participants with account balances2013-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0129
Total number of active participants reported on line 7a of the Form 55002012-01-0126
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0127
Number of participants with account balances2012-01-0125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0131
Total number of active participants reported on line 7a of the Form 55002011-01-0127
Number of retired or separated participants receiving benefits2011-01-011
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0128
Number of participants with account balances2011-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0133
Total number of active participants reported on line 7a of the Form 55002009-01-0132
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0132
Number of participants with account balances2009-01-0131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN

Measure Date Value
2016 : CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2016 401k financial data
Total plan liabilities at end of year2016-10-01$0
Total income from all sources2016-10-01$96,291
Expenses. Total of all expenses incurred2016-10-01$2,811,999
Benefits paid (including direct rollovers)2016-10-01$2,811,999
Total plan assets at end of year2016-10-01$0
Total plan assets at beginning of year2016-10-01$2,715,708
Value of fidelity bond covering the plan2016-10-01$300,000
Other income received2016-10-01$96,291
Net income (gross income less expenses)2016-10-01$-2,715,708
Net plan assets at end of year (total assets less liabilities)2016-10-01$0
Net plan assets at beginning of year (total assets less liabilities)2016-10-01$2,715,708
Assets. Value of participant loans2016-10-01$0
Assets. Value of employer securities2016-10-01$0
2015 : CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2015 401k financial data
Total income from all sources2015-12-31$493,392
Expenses. Total of all expenses incurred2015-12-31$17,292
Benefits paid (including direct rollovers)2015-12-31$9,580
Total plan assets at end of year2015-12-31$2,715,708
Total plan assets at beginning of year2015-12-31$2,239,608
Value of fidelity bond covering the plan2015-12-31$300,000
Total contributions received or receivable from participants2015-12-31$10,029
Expenses. Other expenses not covered elsewhere2015-12-31$7,712
Other income received2015-12-31$412,531
Net income (gross income less expenses)2015-12-31$476,100
Net plan assets at end of year (total assets less liabilities)2015-12-31$2,715,708
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$2,239,608
Assets. Value of participant loans2015-12-31$352
Assets. Value of employer securities2015-12-31$0
Total contributions received or receivable from employer(s)2015-12-31$70,832
2014 : CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2014 401k financial data
Total income from all sources2014-12-31$250,733
Expenses. Total of all expenses incurred2014-12-31$59,751
Benefits paid (including direct rollovers)2014-12-31$51,079
Total plan assets at end of year2014-12-31$2,239,608
Total plan assets at beginning of year2014-12-31$2,048,626
Value of fidelity bond covering the plan2014-12-31$300,000
Total contributions received or receivable from participants2014-12-31$10,010
Expenses. Other expenses not covered elsewhere2014-12-31$8,672
Other income received2014-12-31$163,523
Net income (gross income less expenses)2014-12-31$190,982
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,239,608
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$2,048,626
Assets. Value of participant loans2014-12-31$1,177
Assets. Value of employer securities2014-12-31$1,866,152
Total contributions received or receivable from employer(s)2014-12-31$77,200
2013 : CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2013 401k financial data
Total income from all sources2013-12-31$145,409
Expenses. Total of all expenses incurred2013-12-31$87,656
Benefits paid (including direct rollovers)2013-12-31$78,314
Total plan assets at end of year2013-12-31$2,048,626
Total plan assets at beginning of year2013-12-31$1,990,873
Value of fidelity bond covering the plan2013-12-31$300,000
Total contributions received or receivable from participants2013-12-31$12,667
Expenses. Other expenses not covered elsewhere2013-12-31$9,342
Other income received2013-12-31$57,386
Net income (gross income less expenses)2013-12-31$57,753
Net plan assets at end of year (total assets less liabilities)2013-12-31$2,048,626
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,990,873
Assets. Value of participant loans2013-12-31$1,977
Assets. Value of employer securities2013-12-31$1,690,821
Total contributions received or receivable from employer(s)2013-12-31$75,356
2012 : CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2012 401k financial data
Total income from all sources2012-12-31$-93,876
Expenses. Total of all expenses incurred2012-12-31$389,079
Benefits paid (including direct rollovers)2012-12-31$380,316
Total plan assets at end of year2012-12-31$1,990,873
Total plan assets at beginning of year2012-12-31$2,473,828
Value of fidelity bond covering the plan2012-12-31$300,000
Total contributions received or receivable from participants2012-12-31$13,083
Expenses. Other expenses not covered elsewhere2012-12-31$8,763
Other income received2012-12-31$-187,126
Net income (gross income less expenses)2012-12-31$-482,955
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,990,873
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$2,473,828
Assets. Value of participant loans2012-12-31$2,750
Assets. Value of employer securities2012-12-31$1,651,506
Total contributions received or receivable from employer(s)2012-12-31$80,167
2011 : CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2011 401k financial data
Total income from all sources2011-12-31$366,579
Expenses. Total of all expenses incurred2011-12-31$194,854
Benefits paid (including direct rollovers)2011-12-31$185,464
Total plan assets at end of year2011-12-31$2,473,828
Total plan assets at beginning of year2011-12-31$2,302,103
Value of fidelity bond covering the plan2011-12-31$300,000
Total contributions received or receivable from participants2011-12-31$13,800
Expenses. Other expenses not covered elsewhere2011-12-31$9,390
Other income received2011-12-31$272,661
Net income (gross income less expenses)2011-12-31$171,725
Net plan assets at end of year (total assets less liabilities)2011-12-31$2,473,828
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$2,302,103
Assets. Value of participant loans2011-12-31$3,499
Assets. Value of employer securities2011-12-31$2,144,499
Total contributions received or receivable from employer(s)2011-12-31$80,118
2010 : CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2010 401k financial data
Total income from all sources2010-12-31$-298,762
Expenses. Total of all expenses incurred2010-12-31$67,645
Benefits paid (including direct rollovers)2010-12-31$55,404
Total plan assets at end of year2010-12-31$2,302,103
Total plan assets at beginning of year2010-12-31$2,668,510
Value of fidelity bond covering the plan2010-12-31$300,000
Total contributions received or receivable from participants2010-12-31$14,815
Expenses. Other expenses not covered elsewhere2010-12-31$12,241
Other income received2010-12-31$-405,262
Net income (gross income less expenses)2010-12-31$-366,407
Net plan assets at end of year (total assets less liabilities)2010-12-31$2,302,103
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$2,668,510
Assets. Value of employer securities2010-12-31$1,956,845
Total contributions received or receivable from employer(s)2010-12-31$91,685

Form 5500 Responses for CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN

2016: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: CABOOL STATE BANK EMPLOYEE STOCK OWNERSHIP PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract number7829113,ETC
Policy instance 1
Insurance contract or identification number7829113,ETC
Number of Individuals Covered26
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $153
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $111
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
ILLINOIS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64580 )
Policy contract numberL0497952
Policy instance 4
Insurance contract or identification numberL0497952
Number of Individuals Covered26
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10
Insurance broker organization code?3
Insurance broker nameLARRY LEXOW
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number81409
Policy instance 3
Insurance contract or identification number81409
Number of Individuals Covered26
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,235
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,072
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number15608266, ETC
Policy instance 2
Insurance contract or identification number15608266, ETC
Number of Individuals Covered26
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $49
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract number7829113,ETC
Policy instance 3
Insurance contract or identification number7829113,ETC
Number of Individuals Covered23
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $213
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number81409
Policy instance 2
Insurance contract or identification number81409
Number of Individuals Covered23
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,277
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,971
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number15608266, ETC
Policy instance 1
Insurance contract or identification number15608266, ETC
Number of Individuals Covered23
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $65
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
ILLINOIS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64580 )
Policy contract numberL0497952
Policy instance 4
Insurance contract or identification numberL0497952
Number of Individuals Covered23
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $9
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9
Insurance broker organization code?3
Insurance broker nameLARRY LEXOW
MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract number7829113,ETC
Policy instance 3
Insurance contract or identification number7829113,ETC
Number of Individuals Covered23
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $217
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number15608266, ETC
Policy instance 2
Insurance contract or identification number15608266, ETC
Number of Individuals Covered23
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $94
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
ILLINOIS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64580 )
Policy contract numberL0497952
Policy instance 1
Insurance contract or identification numberL0497952
Number of Individuals Covered23
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11
Insurance broker organization code?3
Insurance broker nameLARRY LEXOW
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number81409
Policy instance 4
Insurance contract or identification number81409
Number of Individuals Covered23
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,278
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,972
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number15608266, ETC
Policy instance 1
Insurance contract or identification number15608266, ETC
Number of Individuals Covered25
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $106
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
ILLINOIS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64580 )
Policy contract numberL0497952
Policy instance 4
Insurance contract or identification numberL0497952
Number of Individuals Covered25
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $98
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98
Insurance broker organization code?3
Insurance broker nameLARRY LEXOW
MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract number7829111,ETC
Policy instance 2
Insurance contract or identification number7829111,ETC
Number of Individuals Covered25
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $191
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number81409
Policy instance 3
Insurance contract or identification number81409
Number of Individuals Covered25
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,287
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,980
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number81409
Policy instance 2
Insurance contract or identification number81409
Number of Individuals Covered28
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,205
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract number7829111,ETC
Policy instance 1
Insurance contract or identification number7829111,ETC
Number of Individuals Covered28
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $252
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number15608266, ETC
Policy instance 3
Insurance contract or identification number15608266, ETC
Number of Individuals Covered28
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $132
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number15608266, ETC
Policy instance 3
Insurance contract or identification number15608266, ETC
Number of Individuals Covered30
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $130
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number81409
Policy instance 1
Insurance contract or identification number81409
Number of Individuals Covered30
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,256
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,957
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM
MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract number7829111,ETC
Policy instance 2
Insurance contract or identification number7829111,ETC
Number of Individuals Covered30
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $245
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2
Insurance broker organization code?3
Insurance broker nameCARL KICKHAM

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