VERSABILITY RESOURCES has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN
401k plan membership statisitcs for VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-08-31 | $327,466 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-08-31 | $343,105 |
| Total income from all sources (including contributions) | 2022-08-31 | $648,753 |
| Total of all expenses incurred | 2022-08-31 | $676,706 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-08-31 | $581,164 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-08-31 | $648,753 |
| Value of total assets at end of year | 2022-08-31 | $184,462 |
| Value of total assets at beginning of year | 2022-08-31 | $228,054 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-08-31 | $95,542 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-08-31 | No |
| Administrative expenses professional fees incurred | 2022-08-31 | $18,000 |
| Was this plan covered by a fidelity bond | 2022-08-31 | Yes |
| Value of fidelity bond cover | 2022-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-08-31 | No |
| Contributions received from participants | 2022-08-31 | $49,248 |
| Participant contributions at end of year | 2022-08-31 | $3,947 |
| Participant contributions at beginning of year | 2022-08-31 | $5,871 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-08-31 | $303,538 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-08-31 | $320,587 |
| Administrative expenses (other) incurred | 2022-08-31 | $77,542 |
| Liabilities. Value of operating payables at end of year | 2022-08-31 | $23,928 |
| Liabilities. Value of operating payables at beginning of year | 2022-08-31 | $22,518 |
| Total non interest bearing cash at end of year | 2022-08-31 | $70,833 |
| Total non interest bearing cash at beginning of year | 2022-08-31 | $74,244 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-08-31 | No |
| Value of net income/loss | 2022-08-31 | $-27,953 |
| Value of net assets at end of year (total assets less liabilities) | 2022-08-31 | $-143,004 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-08-31 | $-115,051 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-08-31 | No |
| Value of interest in pooled separate accounts at end of year | 2022-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-08-31 | $581,164 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-08-31 | No |
| Contributions received in cash from employer | 2022-08-31 | $599,505 |
| Employer contributions (assets) at end of year | 2022-08-31 | $109,682 |
| Employer contributions (assets) at beginning of year | 2022-08-31 | $147,939 |
| 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 | 2022-08-31 | No |
| Did the plan have assets held for investment | 2022-08-31 | 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 | 2022-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-08-31 | Unqualified |
| Accountancy firm name | 2022-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2022-08-31 | 454199441 |
| 2021 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-08-31 | $343,105 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-08-31 | $258,032 |
| Total income from all sources (including contributions) | 2021-08-31 | $711,934 |
| Total of all expenses incurred | 2021-08-31 | $725,698 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-08-31 | $643,785 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-08-31 | $711,934 |
| Value of total assets at end of year | 2021-08-31 | $228,054 |
| Value of total assets at beginning of year | 2021-08-31 | $156,745 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-08-31 | $81,913 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-08-31 | No |
| Administrative expenses professional fees incurred | 2021-08-31 | $17,000 |
| Was this plan covered by a fidelity bond | 2021-08-31 | Yes |
| Value of fidelity bond cover | 2021-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2021-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-08-31 | No |
| Contributions received from participants | 2021-08-31 | $42,560 |
| Participant contributions at end of year | 2021-08-31 | $5,871 |
| Participant contributions at beginning of year | 2021-08-31 | $9,938 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2021-08-31 | $84,791 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-08-31 | $320,587 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-08-31 | $233,638 |
| Administrative expenses (other) incurred | 2021-08-31 | $64,913 |
| Liabilities. Value of operating payables at end of year | 2021-08-31 | $22,518 |
| Liabilities. Value of operating payables at beginning of year | 2021-08-31 | $24,394 |
| Total non interest bearing cash at end of year | 2021-08-31 | $74,244 |
| Total non interest bearing cash at beginning of year | 2021-08-31 | $39,028 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-08-31 | No |
| Value of net income/loss | 2021-08-31 | $-13,764 |
| Value of net assets at end of year (total assets less liabilities) | 2021-08-31 | $-115,051 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-08-31 | $-101,287 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-08-31 | No |
| Value of interest in pooled separate accounts at end of year | 2021-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-08-31 | $558,994 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-08-31 | No |
| Contributions received in cash from employer | 2021-08-31 | $669,374 |
| Employer contributions (assets) at end of year | 2021-08-31 | $147,939 |
| Employer contributions (assets) at beginning of year | 2021-08-31 | $107,779 |
| 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 | 2021-08-31 | No |
| Did the plan have assets held for investment | 2021-08-31 | 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 | 2021-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-08-31 | Unqualified |
| Accountancy firm name | 2021-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2021-08-31 | 454199441 |
| 2020 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-08-31 | $258,032 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-08-31 | $255,151 |
| Total income from all sources (including contributions) | 2020-08-31 | $649,617 |
| Total of all expenses incurred | 2020-08-31 | $653,671 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-08-31 | $587,965 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-08-31 | $649,617 |
| Value of total assets at end of year | 2020-08-31 | $156,745 |
| Value of total assets at beginning of year | 2020-08-31 | $157,918 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-08-31 | $65,706 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-08-31 | No |
| Administrative expenses professional fees incurred | 2020-08-31 | $16,500 |
| Was this plan covered by a fidelity bond | 2020-08-31 | Yes |
| Value of fidelity bond cover | 2020-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2020-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-08-31 | No |
| Contributions received from participants | 2020-08-31 | $44,088 |
| Participant contributions at end of year | 2020-08-31 | $9,938 |
| Participant contributions at beginning of year | 2020-08-31 | $1,602 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2020-08-31 | $-8,750 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-08-31 | $233,638 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-08-31 | $243,681 |
| Administrative expenses (other) incurred | 2020-08-31 | $49,206 |
| Liabilities. Value of operating payables at end of year | 2020-08-31 | $24,394 |
| Liabilities. Value of operating payables at beginning of year | 2020-08-31 | $11,470 |
| Total non interest bearing cash at end of year | 2020-08-31 | $39,028 |
| Total non interest bearing cash at beginning of year | 2020-08-31 | $115,070 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-08-31 | No |
| Value of net income/loss | 2020-08-31 | $-4,054 |
| Value of net assets at end of year (total assets less liabilities) | 2020-08-31 | $-101,287 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-08-31 | $-97,233 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-08-31 | No |
| Value of interest in pooled separate accounts at end of year | 2020-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-08-31 | $596,715 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-08-31 | No |
| Contributions received in cash from employer | 2020-08-31 | $605,529 |
| Employer contributions (assets) at end of year | 2020-08-31 | $107,779 |
| Employer contributions (assets) at beginning of year | 2020-08-31 | $41,246 |
| 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 | 2020-08-31 | No |
| Did the plan have assets held for investment | 2020-08-31 | 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 | 2020-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-08-31 | Unqualified |
| Accountancy firm name | 2020-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2020-08-31 | 454199441 |
| 2019 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-08-31 | $255,151 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-08-31 | $260,503 |
| Total income from all sources (including contributions) | 2019-08-31 | $651,919 |
| Total of all expenses incurred | 2019-08-31 | $662,269 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-08-31 | $592,482 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-08-31 | $651,919 |
| Value of total assets at end of year | 2019-08-31 | $157,918 |
| Value of total assets at beginning of year | 2019-08-31 | $173,620 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-08-31 | $69,787 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-08-31 | No |
| Administrative expenses professional fees incurred | 2019-08-31 | $15,500 |
| Was this plan covered by a fidelity bond | 2019-08-31 | Yes |
| Value of fidelity bond cover | 2019-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2019-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-08-31 | No |
| Contributions received from participants | 2019-08-31 | $26,393 |
| Participant contributions at end of year | 2019-08-31 | $1,602 |
| Participant contributions at beginning of year | 2019-08-31 | $2,935 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-08-31 | $-12,837 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-08-31 | $243,681 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-08-31 | $254,513 |
| Administrative expenses (other) incurred | 2019-08-31 | $54,287 |
| Liabilities. Value of operating payables at end of year | 2019-08-31 | $11,470 |
| Liabilities. Value of operating payables at beginning of year | 2019-08-31 | $5,990 |
| Total non interest bearing cash at end of year | 2019-08-31 | $115,070 |
| Total non interest bearing cash at beginning of year | 2019-08-31 | $116,791 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-08-31 | No |
| Value of net income/loss | 2019-08-31 | $-10,350 |
| Value of net assets at end of year (total assets less liabilities) | 2019-08-31 | $-97,233 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-08-31 | $-86,883 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-08-31 | No |
| Value of interest in pooled separate accounts at end of year | 2019-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-08-31 | $605,319 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-08-31 | No |
| Contributions received in cash from employer | 2019-08-31 | $625,526 |
| Employer contributions (assets) at end of year | 2019-08-31 | $41,246 |
| Employer contributions (assets) at beginning of year | 2019-08-31 | $53,894 |
| 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 | 2019-08-31 | No |
| Did the plan have assets held for investment | 2019-08-31 | 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 | 2019-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-08-31 | Unqualified |
| Accountancy firm name | 2019-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2019-08-31 | 454199441 |
| 2018 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-08-31 | $260,503 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-08-31 | $264,416 |
| Total income from all sources (including contributions) | 2018-08-31 | $645,309 |
| Total of all expenses incurred | 2018-08-31 | $667,369 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-08-31 | $605,529 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-08-31 | $645,309 |
| Value of total assets at end of year | 2018-08-31 | $173,620 |
| Value of total assets at beginning of year | 2018-08-31 | $199,593 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-08-31 | $61,840 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-08-31 | No |
| Administrative expenses professional fees incurred | 2018-08-31 | $15,100 |
| Was this plan covered by a fidelity bond | 2018-08-31 | Yes |
| Value of fidelity bond cover | 2018-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2018-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-08-31 | No |
| Contributions received from participants | 2018-08-31 | $35,183 |
| Participant contributions at end of year | 2018-08-31 | $2,935 |
| Participant contributions at beginning of year | 2018-08-31 | $3,476 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-08-31 | $-9,311 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-08-31 | $254,513 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-08-31 | $260,773 |
| Administrative expenses (other) incurred | 2018-08-31 | $46,740 |
| Liabilities. Value of operating payables at end of year | 2018-08-31 | $5,990 |
| Liabilities. Value of operating payables at beginning of year | 2018-08-31 | $3,643 |
| Total non interest bearing cash at end of year | 2018-08-31 | $116,791 |
| Total non interest bearing cash at beginning of year | 2018-08-31 | $139,567 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-08-31 | No |
| Value of net income/loss | 2018-08-31 | $-22,060 |
| Value of net assets at end of year (total assets less liabilities) | 2018-08-31 | $-86,883 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-08-31 | $-64,823 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-08-31 | No |
| Value of interest in common/collective trusts at end of year | 2018-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-08-31 | $614,840 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-08-31 | No |
| Contributions received in cash from employer | 2018-08-31 | $610,126 |
| Employer contributions (assets) at end of year | 2018-08-31 | $53,894 |
| Employer contributions (assets) at beginning of year | 2018-08-31 | $56,550 |
| 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 | 2018-08-31 | No |
| Did the plan have assets held for investment | 2018-08-31 | 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 | 2018-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-08-31 | Unqualified |
| Accountancy firm name | 2018-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2018-08-31 | 454199441 |
| 2017 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-08-31 | $264,416 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-08-31 | $275,161 |
| Total income from all sources (including contributions) | 2017-08-31 | $602,434 |
| Total of all expenses incurred | 2017-08-31 | $610,779 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-08-31 | $550,623 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-08-31 | $602,434 |
| Value of total assets at end of year | 2017-08-31 | $199,593 |
| Value of total assets at beginning of year | 2017-08-31 | $218,683 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-08-31 | $60,156 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-08-31 | No |
| Administrative expenses professional fees incurred | 2017-08-31 | $14,623 |
| Was this plan covered by a fidelity bond | 2017-08-31 | Yes |
| Value of fidelity bond cover | 2017-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-08-31 | No |
| Contributions received from participants | 2017-08-31 | $40,131 |
| Participant contributions at end of year | 2017-08-31 | $3,476 |
| Participant contributions at beginning of year | 2017-08-31 | $646 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2017-08-31 | $-2,580 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-08-31 | $260,773 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-08-31 | $269,109 |
| Administrative expenses (other) incurred | 2017-08-31 | $45,533 |
| Liabilities. Value of operating payables at end of year | 2017-08-31 | $3,643 |
| Liabilities. Value of operating payables at beginning of year | 2017-08-31 | $6,052 |
| Total non interest bearing cash at end of year | 2017-08-31 | $139,567 |
| Total non interest bearing cash at beginning of year | 2017-08-31 | $168,129 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-08-31 | No |
| Value of net income/loss | 2017-08-31 | $-8,345 |
| Value of net assets at end of year (total assets less liabilities) | 2017-08-31 | $-64,823 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-08-31 | $-56,478 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-08-31 | No |
| Value of interest in common/collective trusts at end of year | 2017-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-08-31 | $553,203 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-08-31 | No |
| Contributions received in cash from employer | 2017-08-31 | $562,303 |
| Employer contributions (assets) at end of year | 2017-08-31 | $56,550 |
| Employer contributions (assets) at beginning of year | 2017-08-31 | $49,908 |
| 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 | 2017-08-31 | No |
| Did the plan have assets held for investment | 2017-08-31 | 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 | 2017-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-08-31 | Unqualified |
| Accountancy firm name | 2017-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2017-08-31 | 454199441 |
| 2016 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-08-31 | $275,161 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-08-31 | $194,183 |
| Total income from all sources (including contributions) | 2016-08-31 | $677,071 |
| Total of all expenses incurred | 2016-08-31 | $691,715 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-08-31 | $635,175 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-08-31 | $677,071 |
| Value of total assets at end of year | 2016-08-31 | $218,683 |
| Value of total assets at beginning of year | 2016-08-31 | $152,349 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-08-31 | $56,540 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-08-31 | No |
| Administrative expenses professional fees incurred | 2016-08-31 | $15,070 |
| Was this plan covered by a fidelity bond | 2016-08-31 | Yes |
| Value of fidelity bond cover | 2016-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-08-31 | No |
| Contributions received from participants | 2016-08-31 | $29,322 |
| Participant contributions at end of year | 2016-08-31 | $646 |
| Participant contributions at beginning of year | 2016-08-31 | $81 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2016-08-31 | $72,180 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-08-31 | $269,109 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-08-31 | $190,184 |
| Administrative expenses (other) incurred | 2016-08-31 | $41,470 |
| Liabilities. Value of operating payables at end of year | 2016-08-31 | $6,052 |
| Liabilities. Value of operating payables at beginning of year | 2016-08-31 | $3,999 |
| Total non interest bearing cash at end of year | 2016-08-31 | $168,129 |
| Total non interest bearing cash at beginning of year | 2016-08-31 | $132,689 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-08-31 | No |
| Value of net income/loss | 2016-08-31 | $-14,644 |
| Value of net assets at end of year (total assets less liabilities) | 2016-08-31 | $-56,478 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-08-31 | $-41,834 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-08-31 | No |
| Value of interest in common/collective trusts at end of year | 2016-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-08-31 | $562,995 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-08-31 | No |
| Contributions received in cash from employer | 2016-08-31 | $647,749 |
| Employer contributions (assets) at end of year | 2016-08-31 | $49,908 |
| Employer contributions (assets) at beginning of year | 2016-08-31 | $19,579 |
| Did the plan have assets held for investment | 2016-08-31 | 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 | 2016-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-08-31 | Unqualified |
| Accountancy firm name | 2016-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2016-08-31 | 454199441 |
| 2015 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-08-31 | $194,183 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-08-31 | $162,959 |
| Total income from all sources (including contributions) | 2015-08-31 | $613,070 |
| Total of all expenses incurred | 2015-08-31 | $626,369 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-08-31 | $570,366 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-08-31 | $613,070 |
| Value of total assets at end of year | 2015-08-31 | $152,349 |
| Value of total assets at beginning of year | 2015-08-31 | $134,424 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-08-31 | $56,003 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-08-31 | No |
| Administrative expenses professional fees incurred | 2015-08-31 | $13,000 |
| Was this plan covered by a fidelity bond | 2015-08-31 | Yes |
| Value of fidelity bond cover | 2015-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-08-31 | No |
| Contributions received from participants | 2015-08-31 | $3,315 |
| Participant contributions at end of year | 2015-08-31 | $81 |
| Participant contributions at beginning of year | 2015-08-31 | $671 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-08-31 | $16,082 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-08-31 | $190,184 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-08-31 | $158,895 |
| Administrative expenses (other) incurred | 2015-08-31 | $43,003 |
| Liabilities. Value of operating payables at end of year | 2015-08-31 | $3,999 |
| Liabilities. Value of operating payables at beginning of year | 2015-08-31 | $4,064 |
| Total non interest bearing cash at end of year | 2015-08-31 | $132,689 |
| Total non interest bearing cash at beginning of year | 2015-08-31 | $88,502 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-08-31 | No |
| Value of net income/loss | 2015-08-31 | $-13,299 |
| Value of net assets at end of year (total assets less liabilities) | 2015-08-31 | $-41,834 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-08-31 | $-28,535 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-08-31 | No |
| Value of interest in common/collective trusts at end of year | 2015-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-08-31 | $554,284 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-08-31 | No |
| Contributions received in cash from employer | 2015-08-31 | $609,755 |
| Employer contributions (assets) at end of year | 2015-08-31 | $19,579 |
| Employer contributions (assets) at beginning of year | 2015-08-31 | $45,251 |
| Did the plan have assets held for investment | 2015-08-31 | 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 | 2015-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-08-31 | Unqualified |
| Accountancy firm name | 2015-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2015-08-31 | 454199441 |
| 2014 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-08-31 | $162,959 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-08-31 | $183,691 |
| Total income from all sources (including contributions) | 2014-08-31 | $532,589 |
| Total of all expenses incurred | 2014-08-31 | $548,522 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-08-31 | $487,870 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-08-31 | $532,589 |
| Value of total assets at end of year | 2014-08-31 | $134,424 |
| Value of total assets at beginning of year | 2014-08-31 | $171,089 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-08-31 | $60,652 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-08-31 | No |
| Administrative expenses professional fees incurred | 2014-08-31 | $12,000 |
| Was this plan covered by a fidelity bond | 2014-08-31 | Yes |
| Value of fidelity bond cover | 2014-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-08-31 | No |
| Contributions received from participants | 2014-08-31 | $8,609 |
| Participant contributions at end of year | 2014-08-31 | $671 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-08-31 | $158,895 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-08-31 | $177,278 |
| Administrative expenses (other) incurred | 2014-08-31 | $48,652 |
| Liabilities. Value of operating payables at end of year | 2014-08-31 | $4,064 |
| Liabilities. Value of operating payables at beginning of year | 2014-08-31 | $6,413 |
| Total non interest bearing cash at end of year | 2014-08-31 | $88,502 |
| Total non interest bearing cash at beginning of year | 2014-08-31 | $171,089 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-08-31 | No |
| Value of net income/loss | 2014-08-31 | $-15,933 |
| Value of net assets at end of year (total assets less liabilities) | 2014-08-31 | $-28,535 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-08-31 | $-12,602 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-08-31 | No |
| Value of interest in common/collective trusts at end of year | 2014-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-08-31 | $487,870 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-08-31 | No |
| Contributions received in cash from employer | 2014-08-31 | $523,980 |
| Employer contributions (assets) at end of year | 2014-08-31 | $45,251 |
| Did the plan have assets held for investment | 2014-08-31 | 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 | 2014-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-08-31 | Unqualified |
| Accountancy firm name | 2014-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2014-08-31 | 454199441 |
| 2013 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-08-31 | $183,691 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-08-31 | $151,148 |
| Total income from all sources (including contributions) | 2013-08-31 | $676,255 |
| Total of all expenses incurred | 2013-08-31 | $685,717 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-08-31 | $629,420 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-08-31 | $676,255 |
| Value of total assets at end of year | 2013-08-31 | $171,089 |
| Value of total assets at beginning of year | 2013-08-31 | $148,008 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-08-31 | $56,297 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-08-31 | No |
| Administrative expenses professional fees incurred | 2013-08-31 | $10,500 |
| Was this plan covered by a fidelity bond | 2013-08-31 | Yes |
| Value of fidelity bond cover | 2013-08-31 | $50,000 |
| If this is an individual account plan, was there a blackout period | 2013-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-08-31 | No |
| Contributions received from participants | 2013-08-31 | $7,138 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-08-31 | $24,104 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-08-31 | $177,278 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-08-31 | $146,300 |
| Administrative expenses (other) incurred | 2013-08-31 | $45,797 |
| Liabilities. Value of operating payables at end of year | 2013-08-31 | $6,413 |
| Liabilities. Value of operating payables at beginning of year | 2013-08-31 | $4,848 |
| Total non interest bearing cash at end of year | 2013-08-31 | $171,089 |
| Total non interest bearing cash at beginning of year | 2013-08-31 | $148,008 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-08-31 | No |
| Value of net income/loss | 2013-08-31 | $-9,462 |
| Value of net assets at end of year (total assets less liabilities) | 2013-08-31 | $-12,602 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-08-31 | $-3,140 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-08-31 | No |
| Value of interest in common/collective trusts at end of year | 2013-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-08-31 | $605,316 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-08-31 | No |
| Contributions received in cash from employer | 2013-08-31 | $669,117 |
| Did the plan have assets held for investment | 2013-08-31 | 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 | 2013-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-08-31 | Unqualified |
| Accountancy firm name | 2013-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2013-08-31 | 454199441 |
| 2012 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $151,148 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $88,678 |
| Total income from all sources (including contributions) | 2012-08-31 | $947,442 |
| Total of all expenses incurred | 2012-08-31 | $981,328 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-08-31 | $914,304 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-08-31 | $947,442 |
| Value of total assets at end of year | 2012-08-31 | $148,008 |
| Value of total assets at beginning of year | 2012-08-31 | $119,424 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-08-31 | $67,024 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-08-31 | No |
| Administrative expenses professional fees incurred | 2012-08-31 | $10,000 |
| Was this plan covered by a fidelity bond | 2012-08-31 | Yes |
| Value of fidelity bond cover | 2012-08-31 | $50,000 |
| If this is an individual account plan, was there a blackout period | 2012-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-08-31 | No |
| Contributions received from participants | 2012-08-31 | $20,730 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-08-31 | $-30,833 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-08-31 | $31,921 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-08-31 | $146,300 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-08-31 | $87,143 |
| Administrative expenses (other) incurred | 2012-08-31 | $57,024 |
| Liabilities. Value of operating payables at end of year | 2012-08-31 | $4,848 |
| Liabilities. Value of operating payables at beginning of year | 2012-08-31 | $1,535 |
| Total non interest bearing cash at end of year | 2012-08-31 | $148,008 |
| Total non interest bearing cash at beginning of year | 2012-08-31 | $119,424 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-08-31 | No |
| Value of net income/loss | 2012-08-31 | $-33,886 |
| Value of net assets at end of year (total assets less liabilities) | 2012-08-31 | $-3,140 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-08-31 | $30,746 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-08-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-08-31 | $882,383 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-08-31 | No |
| Contributions received in cash from employer | 2012-08-31 | $957,545 |
| Did the plan have assets held for investment | 2012-08-31 | Yes |
| 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 | 2012-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-08-31 | Unqualified |
| Accountancy firm name | 2012-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2012-08-31 | 454199441 |
| 2011 : VERSABILITY RESOURCES, INC FRINGE BENEFIT PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-08-31 | $88,678 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-08-31 | $90,439 |
| Total income from all sources (including contributions) | 2011-08-31 | $328,180 |
| Total of all expenses incurred | 2011-08-31 | $327,206 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-08-31 | $294,184 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-08-31 | $328,034 |
| Value of total assets at end of year | 2011-08-31 | $119,424 |
| Value of total assets at beginning of year | 2011-08-31 | $120,211 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-08-31 | $33,022 |
| Total interest from all sources | 2011-08-31 | $5 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-08-31 | No |
| Administrative expenses professional fees incurred | 2011-08-31 | $9,500 |
| Was this plan covered by a fidelity bond | 2011-08-31 | Yes |
| Value of fidelity bond cover | 2011-08-31 | $50,000 |
| If this is an individual account plan, was there a blackout period | 2011-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-08-31 | No |
| Contributions received from participants | 2011-08-31 | $13,079 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-08-31 | $703 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-08-31 | $87,143 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-08-31 | $86,440 |
| Other income not declared elsewhere | 2011-08-31 | $141 |
| Administrative expenses (other) incurred | 2011-08-31 | $23,522 |
| Liabilities. Value of operating payables at end of year | 2011-08-31 | $1,535 |
| Liabilities. Value of operating payables at beginning of year | 2011-08-31 | $3,999 |
| Total non interest bearing cash at end of year | 2011-08-31 | $119,424 |
| Total non interest bearing cash at beginning of year | 2011-08-31 | $120,211 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-08-31 | No |
| Value of net income/loss | 2011-08-31 | $974 |
| Value of net assets at end of year (total assets less liabilities) | 2011-08-31 | $30,746 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-08-31 | $29,772 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-08-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-08-31 | $5 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-08-31 | $293,481 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-08-31 | No |
| Contributions received in cash from employer | 2011-08-31 | $314,955 |
| Did the plan have assets held for investment | 2011-08-31 | Yes |
| 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 | 2011-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-08-31 | Unqualified |
| Accountancy firm name | 2011-08-31 | FRYE & COMPANY, CPAS |
| Accountancy firm EIN | 2011-08-31 | 454199441 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0BQPY 0002 |
| Policy instance | 8 |
| Insurance contract or identification number | GLTD0BQPY 0002 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $3,786 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,087 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,786 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3343650 |
| Policy instance | 1 |
| Insurance contract or identification number | 3343650 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $2,328 | | Total amount of fees paid to insurance company | USD $17,067 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $530,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,328 | | Amount paid for insurance broker fees | 14756 | | Additional information about fees paid to insurance broker | BENEFITS ADVISOR | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8435 |
| Policy instance | 2 |
| Insurance contract or identification number | 8435 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $2,059 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,059 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BQPY 0002 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0BQPY 0002 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $4,726 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,726 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDE0BQPY 0002 |
| Policy instance | 4 |
| Insurance contract or identification number | GUDE0BQPY 0002 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $1,150 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $11,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,150 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUDH0BQPY 0002 |
| Policy instance | 5 |
| Insurance contract or identification number | GUDH0BQPY 0002 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $1,628 | | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $16,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,628 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG 0BQPY 0002 |
| Policy instance | 6 |
| Insurance contract or identification number | GUG 0BQPY 0002 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $5,898 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $166,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,898 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BQPY 0002 |
| Policy instance | 7 |
| Insurance contract or identification number | GLUG0BQPY 0002 | | Number of Individuals Covered | 378 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $3,990 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $50,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,990 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3343650 |
| Policy instance | 1 |
| Insurance contract or identification number | 3343650 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $2,735 | | Total amount of fees paid to insurance company | USD $11,476 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $427,701 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,735 | | Amount paid for insurance broker fees | 11476 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8435 |
| Policy instance | 2 |
| Insurance contract or identification number | 8435 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $2,027 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,027 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BQPY 0002 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0BQPY 0002 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,814 | | 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 | GUDE0BQPY 0002 |
| Policy instance | 4 |
| Insurance contract or identification number | GUDE0BQPY 0002 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $3,035 | | 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 | GUDH0BQPY 0002 |
| Policy instance | 5 |
| Insurance contract or identification number | GUDH0BQPY 0002 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Other welfare benefits provided | ACCIDENT ONLY VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $3,601 | | 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 | GVTL0BQPY 0002 |
| Policy instance | 7 |
| Insurance contract or identification number | GVTL0BQPY 0002 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $12,882 | | 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 0BQPY 0002 |
| Policy instance | 6 |
| Insurance contract or identification number | GUG 0BQPY 0002 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $46,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 44652000V-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 44652000V-0000 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $1,403 | | Total amount of fees paid to insurance company | USD $1,793 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,403 | | Amount paid for insurance broker fees | 1793 | | Additional information about fees paid to insurance broker | BONUS, OVERRIDE & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | AVA5780402 |
| Policy instance | 1 |
| Insurance contract or identification number | AVA5780402 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $1,799 | | Total amount of fees paid to insurance company | USD $308 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $943 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 308 | | Additional information about fees paid to insurance broker | BONUS, OVERRIDE & NON-MONETARY COMPENSATION |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 44652000V-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 44652000V-0000 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $1,046 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,046 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8435 |
| Policy instance | 4 |
| Insurance contract or identification number | 8435 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $3,053 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,702 | | Additional information about fees paid to insurance broker | BONUS, OVERRIDE & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10117841002 |
| Policy instance | 5 |
| Insurance contract or identification number | 10117841002 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $1,188 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $677 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 914356 |
| Policy instance | 6 |
| Insurance contract or identification number | 914356 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of fees paid to insurance company | USD $12,615 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $430,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6809 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | AVA5780402 |
| Policy instance | 1 |
| Insurance contract or identification number | AVA5780402 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,151 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,151 | | Insurance broker organization code? | 3 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 44652000V-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 44652000V-0000 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $11,950 | | Total amount of fees paid to insurance company | USD $1,010 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,950 | | Amount paid for insurance broker fees | 1010 | | Additional information about fees paid to insurance broker | BONUS, OVERRIDE & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 44652000V-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 44652000V-0000 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $732 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $732 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8435 |
| Policy instance | 4 |
| Insurance contract or identification number | 8435 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,813 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,813 | | Additional information about fees paid to insurance broker | BONUS, OVERRIDE & NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10117841002 |
| Policy instance | 5 |
| Insurance contract or identification number | 10117841002 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $1,325 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,165 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,325 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 914356 |
| Policy instance | 6 |
| Insurance contract or identification number | 914356 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of fees paid to insurance company | USD $13,433 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $434,752 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 13433 | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | AVA5780402 |
| Policy instance | 1 |
| Insurance contract or identification number | AVA5780402 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $2,071 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,410 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 05202 |
| Policy instance | 2 |
| Insurance contract or identification number | 05202 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $7,350 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 05202 |
| Policy instance | 3 |
| Insurance contract or identification number | 05202 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of fees paid to insurance company | USD $38,120 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $402,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 44652000V-0000 |
| Policy instance | 4 |
| Insurance contract or identification number | 44652000V-0000 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $4,108 | | Total amount of fees paid to insurance company | USD $1,989 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 44652000V-0000 |
| Policy instance | 5 |
| Insurance contract or identification number | 44652000V-0000 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $10,295 | | Total amount of fees paid to insurance company | USD $4,985 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8435 |
| Policy instance | 6 |
| Insurance contract or identification number | 8435 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $1,741 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | |
| Policy instance | 7 |
| Number of Individuals Covered | 132 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $933 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | HEALTH PPO |
| Policy instance | 5 |
| Insurance contract or identification number | HEALTH PPO | | Number of Individuals Covered | 18 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $10,183 | | Welfare Benefit Premiums Paid to Carrier | USD $91,278 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,183 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8435 |
| Policy instance | 9 |
| Insurance contract or identification number | 8435 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 11156000 |
| Policy instance | 1 |
| Insurance contract or identification number | 11156000 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $6,669 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $66,687 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,669 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 11131000 |
| Policy instance | 2 |
| Insurance contract or identification number | 11131000 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $4,660 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $46,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,660 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | AVA5780401 |
| Policy instance | 3 |
| Insurance contract or identification number | AVA5780401 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $1,103 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,067 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,103 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | AVA5780403 |
| Policy instance | 4 |
| Insurance contract or identification number | AVA5780403 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $234 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,676 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $234 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | HEALTH HMO |
| Policy instance | 6 |
| Insurance contract or identification number | HEALTH HMO | | Number of Individuals Covered | 53 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $31,325 | | Welfare Benefit Premiums Paid to Carrier | USD $280,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,325 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | LIFE INSURANCE |
| Policy instance | 7 |
| Insurance contract or identification number | LIFE INSURANCE | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $4,056 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,056 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | STD |
| Policy instance | 8 |
| Insurance contract or identification number | STD | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $8,771 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,771 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | AVA5780402 |
| Policy instance | 5 |
| Insurance contract or identification number | AVA5780402 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $4,896 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,750 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | HEALTH HMO |
| Policy instance | 7 |
| Insurance contract or identification number | HEALTH HMO | | Number of Individuals Covered | 39 | | Total amount of commissions paid to insurance broker | USD $13,578 | | Total amount of fees paid to insurance company | USD $11,933 | | Welfare Benefit Premiums Paid to Carrier | USD $433,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,578 | | Amount paid for insurance broker fees | 11933 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATIONS & TRAINING | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 44652000V |
| Policy instance | 8 |
| Insurance contract or identification number | 44652000V | | Number of Individuals Covered | 325 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $143,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 11131000 |
| Policy instance | 2 |
| Insurance contract or identification number | 11131000 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $10,558 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $107,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,558 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 11156000 |
| Policy instance | 1 |
| Insurance contract or identification number | 11156000 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $23,338 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $65,291 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,558 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | HEALTH PPO |
| Policy instance | 6 |
| Insurance contract or identification number | HEALTH PPO | | Number of Individuals Covered | 17 | | Total amount of commissions paid to insurance broker | USD $6,797 | | Welfare Benefit Premiums Paid to Carrier | USD $170,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,797 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 91393 |
| Policy instance | 3 |
| Insurance contract or identification number | 91393 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Other welfare benefits provided | MAJOR MEDICAL COMPLIMENT | | Welfare Benefit Premiums Paid to Carrier | USD $16,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 717375 |
| Policy instance | 4 |
| Insurance contract or identification number | 717375 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $2,041 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,041 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2832*GC |
| Policy instance | 1 |
| Insurance contract or identification number | 2832*GC | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $262,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V1857 |
| Policy instance | 3 |
| Insurance contract or identification number | V1857 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $5,231 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,231 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05714842 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05714842 | | Number of Individuals Covered | 417 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $3,347 | | Total amount of fees paid to insurance company | USD $1,686 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,347 | | Amount paid for insurance broker fees | 1686 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 11156000 |
| Policy instance | 5 |
| Insurance contract or identification number | 11156000 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $6,668 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $68,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,668 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 1131000 |
| Policy instance | 6 |
| Insurance contract or identification number | 1131000 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $7,024 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $71,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,024 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 717375 |
| Policy instance | 9 |
| Insurance contract or identification number | 717375 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $1,961 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,961 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 91393 |
| Policy instance | 8 |
| Insurance contract or identification number | 91393 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $2,998 | | Other welfare benefits provided | MAJOR MEDICAL COMPLIMENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,998 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE10225 |
| Policy instance | 7 |
| Insurance contract or identification number | FAE10225 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $1,985 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,985 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 60603*GC |
| Policy instance | 2 |
| Insurance contract or identification number | 60603*GC | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 91393 |
| Policy instance | 2 |
| Insurance contract or identification number | 91393 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of fees paid to insurance company | USD $1,652 | | Other welfare benefits provided | MAJOR MEDICAL COMPLIMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,010 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1652 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE10225 |
| Policy instance | 3 |
| Insurance contract or identification number | FAE10225 | | Number of Individuals Covered | 81 | | Total amount of commissions paid to insurance broker | USD $1,995 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,995 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 1131000 |
| Policy instance | 4 |
| Insurance contract or identification number | 1131000 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $10,367 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,367 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 11156000 |
| Policy instance | 5 |
| Insurance contract or identification number | 11156000 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $8,225 | | Other welfare benefits provided | FIXED PAYMENT INDEMNITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,225 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | V1857 |
| Policy instance | 7 |
| Insurance contract or identification number | V1857 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $9,091 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,091 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 60603*GC |
| Policy instance | 8 |
| Insurance contract or identification number | 60603*GC | | Number of Individuals Covered | 5 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2832*GC |
| Policy instance | 9 |
| Insurance contract or identification number | 2832*GC | | Number of Individuals Covered | 65 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05714842 |
| Policy instance | 6 |
| Insurance contract or identification number | TM05714842 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $3,207 | | Total amount of fees paid to insurance company | USD $1,085 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,138 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,207 | | Amount paid for insurance broker fees | 1085 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 717375 |
| Policy instance | 1 |
| Insurance contract or identification number | 717375 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $522 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $522 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AE1M |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0AE1M | | Number of Individuals Covered | 187 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-09-01 | | Total amount of commissions paid to insurance broker | USD $4,855 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,356 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 11156 |
| Policy instance | 1 |
| Insurance contract or identification number | 11156 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $18,851 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 717375 |
| Policy instance | 2 |
| Insurance contract or identification number | 717375 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $2,257 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05714842 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05714842 | | Number of Individuals Covered | 387 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $3,349 | | Total amount of fees paid to insurance company | USD $1,005 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,342 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2832*GC |
| Policy instance | 6 |
| Insurance contract or identification number | 2832*GC | | Number of Individuals Covered | 67 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Health Insurance Welfare Benefit | Yes | | 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 | GLUG0AE1M |
| Policy instance | 5 |
| Insurance contract or identification number | GLUG0AE1M | | Number of Individuals Covered | 59 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-09-01 | | Total amount of commissions paid to insurance broker | USD $1,084 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2832*GC |
| Policy instance | 6 |
| Insurance contract or identification number | 2832*GC | | Number of Individuals Covered | 65 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 717375 |
| Policy instance | 1 |
| Insurance contract or identification number | 717375 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $1,463 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 60603*GC |
| Policy instance | 5 |
| Insurance contract or identification number | 60603*GC | | Number of Individuals Covered | 3 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05714842 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05714842 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $3,804 | | Total amount of fees paid to insurance company | USD $1,385 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,953 | | 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 | GLUG0AE1M |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0AE1M | | Number of Individuals Covered | 65 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-09-01 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,613 | | 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 | GUG0AE1M |
| Policy instance | 3 |
| Insurance contract or identification number | GUG0AE1M | | Number of Individuals Covered | 195 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-09-01 | | Total amount of commissions paid to insurance broker | USD $3,843 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
