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ENGAGE LLC 401(K) PLAN 401k Plan overview

Plan NameENGAGE LLC 401(K) PLAN
Plan identification number 001

ENGAGE LLC 401(K) 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.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ENGAGE LLC has sponsored the creation of one or more 401k plans.

Company Name:ENGAGE LLC
Employer identification number (EIN):522274874
NAIC Classification:518210
NAIC Description:Data Processing, Hosting, and Related Services

Additional information about ENGAGE LLC

Jurisdiction of Incorporation: Maryland Secretary of State
Incorporation Date:
Company Identification Number: W06018469

More information about ENGAGE LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENGAGE LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01KATHLEEN CLEM2024-07-10
0012022-01-01
0012021-01-01
0012021-01-01
0012020-01-01
0012020-01-01
0012019-01-01KATHLEEN CLEM2020-09-22
0012018-01-01
0012017-01-01
0012016-01-01AMANDA MIELKE2017-06-15
0012015-01-01TIM LARSEN2016-06-29
0012014-01-01KAYLA BRISSI2015-07-09

Plan Statistics for ENGAGE LLC 401(K) PLAN

401k plan membership statisitcs for ENGAGE LLC 401(K) PLAN

Measure Date Value
2022: ENGAGE LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01128
Total number of active participants reported on line 7a of the Form 55002022-01-01112
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0112
Total of all active and inactive participants2022-01-01124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01124
Number of participants with account balances2022-01-0199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-013
2021: ENGAGE LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01118
Total number of active participants reported on line 7a of the Form 55002021-01-01106
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0120
Total of all active and inactive participants2021-01-01126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01126
Number of participants with account balances2021-01-0193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-013
2020: ENGAGE LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01117
Total number of active participants reported on line 7a of the Form 55002020-01-01101
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0117
Total of all active and inactive participants2020-01-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01118
Number of participants with account balances2020-01-0188
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-013
2019: ENGAGE LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01122
Total number of active participants reported on line 7a of the Form 55002019-01-01110
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-015
Total of all active and inactive participants2019-01-01116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01116
Number of participants with account balances2019-01-0179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-011

Financial Data on ENGAGE LLC 401(K) PLAN

Measure Date Value
2022 : ENGAGE LLC 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-66,654
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$229,021
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$226,991
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$433,339
Value of total assets at end of year2022-12-31$3,977,585
Value of total assets at beginning of year2022-12-31$4,273,260
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$2,030
Total interest from all sources2022-12-31$14,054
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$49,188
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$49,188
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$313,549
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-295,675
Value of net assets at end of year (total assets less liabilities)2022-12-31$3,977,585
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$4,273,260
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$3,079,153
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$2,631,753
Interest on participant loans2022-12-31$0
Income. Interest from loans (other than to participants)2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$898,432
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$1,641,507
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$1,641,507
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$14,054
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-563,235
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$119,790
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$226,991
Contract administrator fees2022-12-31$2,030
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31BERNARD ROBINSON & COMPANY, LLP
Accountancy firm EIN2022-12-31560571159
2021 : ENGAGE LLC 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$885,267
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$57,543
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$55,871
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$373,705
Value of total assets at end of year2021-12-31$4,273,260
Value of total assets at beginning of year2021-12-31$3,445,536
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$1,672
Total interest from all sources2021-12-31$115
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$29,321
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$29,321
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$259,046
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$11,873
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$827,724
Value of net assets at end of year (total assets less liabilities)2021-12-31$4,273,260
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$3,445,536
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$2,631,753
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$3,315,471
Interest on participant loans2021-12-31$0
Income. Interest from loans (other than to participants)2021-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$1,641,507
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$130,065
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$130,065
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$115
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$482,126
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$102,786
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$55,871
Contract administrator fees2021-12-31$1,672
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31BERNARD ROBINSON & COMPANY, LLP
Accountancy firm EIN2021-12-31560571159
2020 : ENGAGE LLC 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$779,761
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$27,335
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$26,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$349,068
Value of total assets at end of year2020-12-31$3,445,536
Value of total assets at beginning of year2020-12-31$2,693,110
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$409
Total interest from all sources2020-12-31$310
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$44,635
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$44,635
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$242,461
Administrative expenses (other) incurred2020-12-31$65
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$752,426
Value of net assets at end of year (total assets less liabilities)2020-12-31$3,445,536
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$2,693,110
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$3,315,471
Value of interest in pooled separate accounts at end of year2020-12-31$0
Value of interest in pooled separate accounts at beginning of year2020-12-31$2,586,059
Interest on participant loans2020-12-31$0
Income. Interest from loans (other than to participants)2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$130,065
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$310
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$107,051
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$385,748
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$106,607
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$26,926
Contract administrator fees2020-12-31$344
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31BERNARD ROBINSON & COMPANY, LLP
Accountancy firm EIN2020-12-31560571159
2019 : ENGAGE LLC 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$743,274
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$34,025
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$33,908
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$317,020
Value of total assets at end of year2019-12-31$2,693,110
Value of total assets at beginning of year2019-12-31$1,983,861
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$117
Total interest from all sources2019-12-31$3,196
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$250,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$215,477
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$2,291
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$709,249
Value of net assets at end of year (total assets less liabilities)2019-12-31$2,693,110
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,983,861
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$2,586,059
Value of interest in pooled separate accounts at beginning of year2019-12-31$1,892,458
Interest earned on other investments2019-12-31$3,196
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$107,051
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$91,403
Net investment gain/loss from pooled separate accounts2019-12-31$423,058
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$99,252
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$33,908
Contract administrator fees2019-12-31$117
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31BERNARD ROBINSON & COMPANY, LLP
Accountancy firm EIN2019-12-31560571159

Form 5500 Responses for ENGAGE LLC 401(K) PLAN

2022: ENGAGE LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: ENGAGE LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: ENGAGE LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: ENGAGE LLC 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

SENTRY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68810 )
Policy contract number010933501
Policy instance 1
Insurance contract or identification number010933501
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $360
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $360
Insurance broker organization code?3
SENTRY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68810 )
Policy contract number010933501
Policy instance 1
Insurance contract or identification number010933501
Number of Individuals Covered116
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,983
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,983
Insurance broker organization code?3

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