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RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 401k Plan overview

Plan NameRAFFIELD TIRE MASTERS, INC. 401(K) PLAN
Plan identification number 001

RAFFIELD TIRE MASTERS, INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

RAFFIELD TIRE MASTERS INC has sponsored the creation of one or more 401k plans.

Company Name:RAFFIELD TIRE MASTERS INC
Employer identification number (EIN):581148603
NAIC Classification:441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Additional information about RAFFIELD TIRE MASTERS INC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 509105

More information about RAFFIELD TIRE MASTERS INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RAFFIELD TIRE MASTERS, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01MARION BATTLE2023-08-31
0012021-01-01MARION BATTLE2022-10-05
0012020-01-01MARION BATTLE2021-09-01
0012019-01-01MARION BATTLE2020-07-23
0012018-01-01COLISTA BATTLE
0012017-01-01COLISTA BATTLE
0012016-01-01COLISTA BATTLE
0012015-01-01COLISTA BATTLE
0012014-01-01COLISTA BATTLE
0012013-01-01COLISTA BATTLE
0012012-01-01COLISTA BATTLE
0012011-01-01COLISTA BATTLE
0012010-01-01COLISTA BATTLE
0012009-01-01COLISTA BATTLE COLISTA BATTLE2010-07-13
0012009-01-012010-07-06

Plan Statistics for RAFFIELD TIRE MASTERS, INC. 401(K) PLAN

401k plan membership statisitcs for RAFFIELD TIRE MASTERS, INC. 401(K) PLAN

Measure Date Value
2018: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0193
Total number of active participants reported on line 7a of the Form 55002018-01-0155
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-0132
Total of all active and inactive participants2018-01-0188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0188
Number of participants with account balances2018-01-0185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-017
2017: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0182
Total number of active participants reported on line 7a of the Form 55002017-01-0164
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0125
Total of all active and inactive participants2017-01-0189
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0189
Number of participants with account balances2017-01-0189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-015
2016: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0179
Total number of active participants reported on line 7a of the Form 55002016-01-0165
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0114
Total of all active and inactive participants2016-01-0179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0179
Number of participants with account balances2016-01-0179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0179
Total number of active participants reported on line 7a of the Form 55002015-01-0159
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0113
Total of all active and inactive participants2015-01-0172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0172
Number of participants with account balances2015-01-0135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0185
Total number of active participants reported on line 7a of the Form 55002014-01-0158
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0117
Total of all active and inactive participants2014-01-0175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0175
Number of participants with account balances2014-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0187
Total number of active participants reported on line 7a of the Form 55002013-01-0164
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0115
Total of all active and inactive participants2013-01-0179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0179
Number of participants with account balances2013-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0188
Total number of active participants reported on line 7a of the Form 55002012-01-0161
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0118
Total of all active and inactive participants2012-01-0179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0179
Number of participants with account balances2012-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-013
2011: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0190
Total number of active participants reported on line 7a of the Form 55002011-01-0169
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0116
Total of all active and inactive participants2011-01-0185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0185
Number of participants with account balances2011-01-0152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0191
Total number of active participants reported on line 7a of the Form 55002010-01-0167
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0119
Total of all active and inactive participants2010-01-0186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0186
Number of participants with account balances2010-01-0156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-011
2009: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0183
Total number of active participants reported on line 7a of the Form 55002009-01-0161
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0119
Total of all active and inactive participants2009-01-0180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0180
Number of participants with account balances2009-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011

Financial Data on RAFFIELD TIRE MASTERS, INC. 401(K) PLAN

Measure Date Value
2018 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$19,129
Expenses. Total of all expenses incurred2018-12-31$54,664
Benefits paid (including direct rollovers)2018-12-31$48,597
Total plan assets at end of year2018-12-31$2,249,669
Total plan assets at beginning of year2018-12-31$2,285,204
Value of fidelity bond covering the plan2018-12-31$500,000
Total contributions received or receivable from participants2018-12-31$26,909
Contributions received from other sources (not participants or employers)2018-12-31$-14,117
Net income (gross income less expenses)2018-12-31$-35,535
Net plan assets at end of year (total assets less liabilities)2018-12-31$2,249,669
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$2,285,204
Total contributions received or receivable from employer(s)2018-12-31$6,337
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$6,067
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$185,750
Expenses. Total of all expenses incurred2017-12-31$41,638
Benefits paid (including direct rollovers)2017-12-31$32,407
Total plan assets at end of year2017-12-31$2,285,204
Total plan assets at beginning of year2017-12-31$2,141,092
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$32,173
Other income received2017-12-31$121,769
Net income (gross income less expenses)2017-12-31$144,112
Net plan assets at end of year (total assets less liabilities)2017-12-31$2,285,204
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$2,141,092
Total contributions received or receivable from employer(s)2017-12-31$31,808
Value of corrective distributions2017-12-31$3,695
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$5,536
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2016 401k financial data
Total income from all sources2016-12-31$243,495
Expenses. Total of all expenses incurred2016-12-31$72,395
Benefits paid (including direct rollovers)2016-12-31$64,325
Total plan assets at end of year2016-12-31$2,141,092
Total plan assets at beginning of year2016-12-31$1,969,992
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$52,172
Other income received2016-12-31$96,020
Net income (gross income less expenses)2016-12-31$171,100
Net plan assets at end of year (total assets less liabilities)2016-12-31$2,141,092
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,969,992
Total contributions received or receivable from employer(s)2016-12-31$95,303
Value of corrective distributions2016-12-31$1,807
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$6,263
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2015 401k financial data
Total income from all sources2015-12-31$98,493
Expenses. Total of all expenses incurred2015-12-31$260,963
Benefits paid (including direct rollovers)2015-12-31$254,399
Total plan assets at end of year2015-12-31$1,969,992
Total plan assets at beginning of year2015-12-31$2,132,462
Value of fidelity bond covering the plan2015-12-31$500,000
Total contributions received or receivable from participants2015-12-31$52,258
Expenses. Other expenses not covered elsewhere2015-12-31$6,564
Other income received2015-12-31$34,030
Net income (gross income less expenses)2015-12-31$-162,470
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,969,992
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$2,132,462
Total contributions received or receivable from employer(s)2015-12-31$12,205
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2014 401k financial data
Total income from all sources2014-12-31$156,260
Expenses. Total of all expenses incurred2014-12-31$247,673
Benefits paid (including direct rollovers)2014-12-31$241,879
Total plan assets at end of year2014-12-31$2,132,462
Total plan assets at beginning of year2014-12-31$2,223,875
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$69,207
Other income received2014-12-31$73,292
Net income (gross income less expenses)2014-12-31$-91,413
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,132,462
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$2,223,875
Total contributions received or receivable from employer(s)2014-12-31$13,761
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$5,794
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$245,829
Expenses. Total of all expenses incurred2013-12-31$330,478
Benefits paid (including direct rollovers)2013-12-31$324,583
Total plan assets at end of year2013-12-31$2,223,875
Total plan assets at beginning of year2013-12-31$2,308,524
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$86,204
Other income received2013-12-31$145,353
Net income (gross income less expenses)2013-12-31$-84,649
Net plan assets at end of year (total assets less liabilities)2013-12-31$2,223,875
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$2,308,524
Total contributions received or receivable from employer(s)2013-12-31$14,272
Value of corrective distributions2013-12-31$2,348
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$3,547
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$239,460
Expenses. Total of all expenses incurred2012-12-31$69,646
Benefits paid (including direct rollovers)2012-12-31$63,064
Total plan assets at end of year2012-12-31$2,308,524
Total plan assets at beginning of year2012-12-31$2,138,710
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$107,851
Other income received2012-12-31$113,102
Net income (gross income less expenses)2012-12-31$169,814
Net plan assets at end of year (total assets less liabilities)2012-12-31$2,308,524
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$2,138,710
Total contributions received or receivable from employer(s)2012-12-31$18,507
Value of corrective distributions2012-12-31$1,341
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$5,241
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2011 401k financial data
Total income from all sources2011-12-31$68,581
Expenses. Total of all expenses incurred2011-12-31$222,472
Benefits paid (including direct rollovers)2011-12-31$203,412
Total plan assets at end of year2011-12-31$2,138,710
Total plan assets at beginning of year2011-12-31$2,292,601
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$122,731
Expenses. Other expenses not covered elsewhere2011-12-31$17,674
Other income received2011-12-31$-74,537
Net income (gross income less expenses)2011-12-31$-153,891
Net plan assets at end of year (total assets less liabilities)2011-12-31$2,138,710
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$2,292,601
Total contributions received or receivable from employer(s)2011-12-31$20,387
Value of corrective distributions2011-12-31$1,386
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2010 401k financial data
Total income from all sources2010-12-31$421,784
Expenses. Total of all expenses incurred2010-12-31$21,230
Benefits paid (including direct rollovers)2010-12-31$688
Total plan assets at end of year2010-12-31$2,292,601
Total plan assets at beginning of year2010-12-31$1,892,047
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$149,013
Other income received2010-12-31$247,993
Net income (gross income less expenses)2010-12-31$400,554
Net plan assets at end of year (total assets less liabilities)2010-12-31$2,292,601
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,892,047
Total contributions received or receivable from employer(s)2010-12-31$24,778
Value of corrective distributions2010-12-31$513
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$20,029
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for RAFFIELD TIRE MASTERS, INC. 401(K) PLAN

2018: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: RAFFIELD TIRE MASTERS, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number85660-1
Policy instance 1
Insurance contract or identification number85660-1
Number of Individuals Covered88
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $8,468
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,666
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number85660-1
Policy instance 1
Insurance contract or identification number85660-1
Number of Individuals Covered80
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $9,374
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,332
Insurance broker organization code?3
Insurance broker nameWILLIAM J MCQUAID
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number85660-1
Policy instance 1
Insurance contract or identification number85660-1
Number of Individuals Covered35
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,497
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,864
Insurance broker organization code?3
Insurance broker nameWILLIAM J MCQUAID
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number85660-1
Policy instance 1
Insurance contract or identification number85660-1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $9,183
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,183
Insurance broker organization code?3
Insurance broker nameWILLIAM J MCQUAID
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number85660-1
Policy instance 1
Insurance contract or identification number85660-1
Number of Individuals Covered45
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11,951
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,892
Insurance broker organization code?3
Insurance broker nameWILLIAM J MCQUAID
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number85660-1
Policy instance 1
Insurance contract or identification number85660-1
Number of Individuals Covered49
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $27,282
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,326
Insurance broker organization code?3
Insurance broker nameANDREW WATSON
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number61060
Policy instance 1
Insurance contract or identification number61060
Number of Individuals Covered0
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,545
Total amount of fees paid to insurance companyUSD $25
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number61060
Policy instance 1
Insurance contract or identification number61060
Number of Individuals Covered64
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,276
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $4,079
Insurance broker organization code?3
Insurance broker nameJOE DREW

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