401k Plan data: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN plan

TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 401k Plan overview

Plan Name	TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN
Plan identification number	501

TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Death benefits (include travel accident but not life insurance)
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

TOBUL ACCUMULATOR INCORPORATED has sponsored the creation of one or more 401k plans.

Company Name: TOBUL ACCUMULATOR INCORPORATED

Employer identification number (EIN): 570913461

NAIC Classification: 332900

Additional information about TOBUL ACCUMULATOR INCORPORATED

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2014-07-03

Company Identification Number: 0802021614

Legal Registered Office Address: 7540 FAIRVIEW ST

HOUSTON
United States of America (USA)
77041

More information about TOBUL ACCUMULATOR INCORPORATED

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 JUDY PARKER
501 2015-01-01 JUDY PARKER
501 2014-01-01 MARK SCHMIDT

Plan id#	Filing Submission Date	Name of Administrator
501	2016-01-01	JUDY PARKER
501	2015-01-01	JUDY PARKER
501	2014-01-01	MARK SCHMIDT

Plan Statistics for TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN

401k plan membership statisitcs for TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN

Measure Date Value
2016: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
2015: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 97
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 99
2014: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 125
Total of all active and inactive participants 2014-01-01 125

Measure	Date	Value
2016: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
2015: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	97
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	99
2014: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	125
Total of all active and inactive participants	2014-01-01	125

Form 5500 Responses for TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN

2016: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: TOBUL ACCUMULATOR, INC. EMPLOYEE GROUP BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

BA638

Policy instance

Insurance contract or identification number	BA638
Number of Individuals Covered	90
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $53,970
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,970
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	THE NASH AGENCY, INC.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00317228

Policy instance

Insurance contract or identification number	00317228
Number of Individuals Covered	96
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,442
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $85,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,909
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

PHYSICIANS EYECARE PLAN (National Association of Insurance Commissioners NAIC id number: 15447 )

Policy contract number

00224

Policy instance

Insurance contract or identification number	00224
Number of Individuals Covered	132
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $751
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $7,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $455
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	SENN DUNN INSURANCE

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

BA638

Policy instance

Insurance contract or identification number	BA638
Number of Individuals Covered	110
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $48,000
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,000
Insurance broker organization code?	3
Insurance broker name	THE NASH AGENCY, INC.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00317228

Policy instance

Insurance contract or identification number	00317228
Number of Individuals Covered	125
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,773
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,557
Insurance broker name	HIBBITS INSURANCE INC.

PHYSICIANS EYECARE PLAN (National Association of Insurance Commissioners NAIC id number: 15447 )

Policy contract number

00224

Policy instance

Insurance contract or identification number	00224
Number of Individuals Covered	120
Insurance policy start date	2014-03-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $811
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	811
Insurance broker name

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Company Name:	TOBUL ACCUMULATOR INCORPORATED
Employer identification number (EIN):	570913461
NAIC Classification:	332900

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2014-07-03
Company Identification Number:	0802021614
Legal Registered Office Address:	7540 FAIRVIEW ST HOUSTON United States of America (USA) 77041