DAVID CONSTRUCTION, INC. has sponsored the creation of one or more 401k plans.
Additional information about DAVID CONSTRUCTION, INC.
Submission information for form 5500 for 401k plan DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN
401k plan membership statisitcs for DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2015: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 20 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 20 |
| Total of all active and inactive participants | 2015-11-01 | 20 |
| Total participants | 2015-11-01 | 20 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-11-01 | 0 |
| 2014: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 20 |
| Total of all active and inactive participants | 2014-11-01 | 20 |
| Total participants | 2014-11-01 | 20 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-11-01 | 0 |
| 2013: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 25 |
| Total of all active and inactive participants | 2013-11-01 | 25 |
| Total participants | 2013-11-01 | 25 |
| 2012: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 15 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 25 |
| Total of all active and inactive participants | 2012-11-01 | 25 |
| Total participants | 2012-11-01 | 25 |
| 2011: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 15 |
| Total of all active and inactive participants | 2011-11-01 | 15 |
| Total participants | 2011-11-01 | 15 |
| 2009: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 30 |
| Total of all active and inactive participants | 2009-11-01 | 30 |
| Total participants | 2009-11-01 | 30 |
| Measure | Date | Value |
|---|
| 2016 : DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-10-31 | $166,385 |
| Expenses. Total of all expenses incurred | 2016-10-31 | $188,041 |
| Benefits paid (including direct rollovers) | 2016-10-31 | $187,291 |
| Total plan assets at end of year | 2016-10-31 | $119,549 |
| Total plan assets at beginning of year | 2016-10-31 | $141,205 |
| Value of fidelity bond covering the plan | 2016-10-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2016-10-31 | $48,602 |
| Expenses. Other expenses not covered elsewhere | 2016-10-31 | $300 |
| Net income (gross income less expenses) | 2016-10-31 | $-21,656 |
| Net plan assets at end of year (total assets less liabilities) | 2016-10-31 | $119,549 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-10-31 | $141,205 |
| Total contributions received or receivable from employer(s) | 2016-10-31 | $117,783 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-10-31 | $450 |
| 2015 : DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-10-31 | $303,857 |
| Expenses. Total of all expenses incurred | 2015-10-31 | $247,628 |
| Benefits paid (including direct rollovers) | 2015-10-31 | $245,208 |
| Total plan assets at end of year | 2015-10-31 | $141,205 |
| Total plan assets at beginning of year | 2015-10-31 | $84,976 |
| Value of fidelity bond covering the plan | 2015-10-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2015-10-31 | $53,109 |
| Expenses. Other expenses not covered elsewhere | 2015-10-31 | $1,920 |
| Net income (gross income less expenses) | 2015-10-31 | $56,229 |
| Net plan assets at end of year (total assets less liabilities) | 2015-10-31 | $141,205 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-10-31 | $84,976 |
| Total contributions received or receivable from employer(s) | 2015-10-31 | $250,748 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-10-31 | $500 |
| 2014 : DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-10-31 | $301,034 |
| Expenses. Total of all expenses incurred | 2014-10-31 | $250,484 |
| Benefits paid (including direct rollovers) | 2014-10-31 | $247,505 |
| Total plan assets at end of year | 2014-10-31 | $84,976 |
| Total plan assets at beginning of year | 2014-10-31 | $34,426 |
| Value of fidelity bond covering the plan | 2014-10-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2014-10-31 | $61,941 |
| Net income (gross income less expenses) | 2014-10-31 | $50,550 |
| Net plan assets at end of year (total assets less liabilities) | 2014-10-31 | $84,976 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-10-31 | $34,426 |
| Total contributions received or receivable from employer(s) | 2014-10-31 | $239,093 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-10-31 | $2,979 |
| 2013 : DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-10-31 | $192,922 |
| Expenses. Total of all expenses incurred | 2013-10-31 | $282,472 |
| Benefits paid (including direct rollovers) | 2013-10-31 | $274,871 |
| Total plan assets at end of year | 2013-10-31 | $34,426 |
| Total plan assets at beginning of year | 2013-10-31 | $123,976 |
| Value of fidelity bond covering the plan | 2013-10-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2013-10-31 | $59,070 |
| Other income received | 2013-10-31 | $5 |
| Net income (gross income less expenses) | 2013-10-31 | $-89,550 |
| Net plan assets at end of year (total assets less liabilities) | 2013-10-31 | $34,426 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-10-31 | $123,976 |
| Total contributions received or receivable from employer(s) | 2013-10-31 | $133,847 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-10-31 | $7,601 |
| 2012 : DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-10-31 | $112,068 |
| Expenses. Total of all expenses incurred | 2012-10-31 | $167,759 |
| Benefits paid (including direct rollovers) | 2012-10-31 | $167,759 |
| Total plan assets at end of year | 2012-10-31 | $123,976 |
| Total plan assets at beginning of year | 2012-10-31 | $179,667 |
| Value of fidelity bond covering the plan | 2012-10-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2012-10-31 | $37,345 |
| Other income received | 2012-10-31 | $32 |
| Net income (gross income less expenses) | 2012-10-31 | $-55,691 |
| Net plan assets at end of year (total assets less liabilities) | 2012-10-31 | $123,976 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-10-31 | $179,667 |
| Total contributions received or receivable from employer(s) | 2012-10-31 | $74,691 |
| 2011 : DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-10-31 | $249,007 |
| Expenses. Total of all expenses incurred | 2011-10-31 | $286,646 |
| Benefits paid (including direct rollovers) | 2011-10-31 | $286,646 |
| Total plan assets at end of year | 2011-10-31 | $179,667 |
| Total plan assets at beginning of year | 2011-10-31 | $217,306 |
| Value of fidelity bond covering the plan | 2011-10-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2011-10-31 | $82,142 |
| Other income received | 2011-10-31 | $93 |
| Net income (gross income less expenses) | 2011-10-31 | $-37,639 |
| Net plan assets at end of year (total assets less liabilities) | 2011-10-31 | $179,667 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-10-31 | $217,306 |
| Total contributions received or receivable from employer(s) | 2011-10-31 | $166,772 |
| 2015: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan funding arrangement – Trust | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement - Trust | Yes |
| 2014: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – Trust | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement - Trust | Yes |
| 2013: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan funding arrangement – Trust | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement - Trust | Yes |
| 2012: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan funding arrangement – Trust | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement - Trust | Yes |
| 2011: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan funding arrangement – Trust | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement - Trust | Yes |
| 2009: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan funding arrangement – Trust | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement - Trust | Yes |
| 2008: DAVID CONSTRUCTION, INC. EMPLOYEE BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-11-01 | Type of plan entity | Single employer plan |
| 2008-11-01 | Submission has been amended | No |
| 2008-11-01 | This submission is the final filing | No |
| 2008-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-11-01 | Plan is a collectively bargained plan | No |
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 541259 |
| Policy instance | 1 |
| Insurance contract or identification number | 541259 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $4,390 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,713 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,390 | | Insurance broker organization code? | 3 | | Insurance broker name | KENTUCKIANA INSURANCE WORKS |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 541259 |
| Policy instance | 4 |
| Insurance contract or identification number | 541259 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-11-01 | | Total amount of commissions paid to insurance broker | USD $1,208 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,623 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,208 | | Insurance broker organization code? | 3 | | Insurance broker name | KENTUCKIANA INSURANCE WORKS |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4136560 |
| Policy instance | 3 |
| Insurance contract or identification number | E4136560 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $2,068 | | Total amount of fees paid to insurance company | USD $236 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,167 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 117 | | Insurance broker name | ALLISON LUCKETT |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1035038 |
| Policy instance | 2 |
| Insurance contract or identification number | 1035038 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $2,185 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,185 | | Insurance broker organization code? | 3 | | Insurance broker name | KENTUCKIANA INSURANCE WORKS. |
|
| TIME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | M10104 |
| Policy instance | 4 |
| Insurance contract or identification number | M10104 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-11-01 | | Total amount of commissions paid to insurance broker | USD $4,807 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $961 | | Insurance broker organization code? | 3 | | Insurance broker name | OLD KENTUCKY INSURANCE, INC. |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1035038 |
| Policy instance | 2 |
| Insurance contract or identification number | 1035038 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $2,726 | | 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 $16,587 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,425 | | Insurance broker organization code? | 3 | | Insurance broker name | HR WORKS INC |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 541259 |
| Policy instance | 1 |
| Insurance contract or identification number | 541259 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $1,115 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,170 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $568 | | Insurance broker organization code? | 3 | | Insurance broker name | KENTUCKIANA INSURANCE WORKS |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4136560 |
| Policy instance | 3 |
| Insurance contract or identification number | E4136560 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $3,766 | | Total amount of fees paid to insurance company | USD $578 | | Other welfare benefits provided | MEDICAL BRIDGE | | Welfare Benefit Premiums Paid to Carrier | USD $21,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $939 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 255 | | Additional information about fees paid to insurance broker | BONUSES AND NONCASH INCENTIVES | | Insurance broker name | KENTUCKIANA INSURANCE WORKS |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4136560 |
| Policy instance | 3 |
| Insurance contract or identification number | E4136560 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $10,354 | | Total amount of fees paid to insurance company | USD $2,600 | | Other welfare benefits provided | MEDICAL BRIDGE | | Welfare Benefit Premiums Paid to Carrier | USD $21,051 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,760 | | Amount paid for insurance broker fees | 1182 | | Additional information about fees paid to insurance broker | BONUSES AND NONCASH INCENTIVES | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM JACK MITCHELL JR |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1035038 |
| Policy instance | 2 |
| Insurance contract or identification number | 1035038 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $2,771 | | 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 $20,056 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,771 | | Insurance broker organization code? | 3 | | Insurance broker name | OLD KENTUCKY INSURANCE, INC. |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 541259 |
| Policy instance | 1 |
| Insurance contract or identification number | 541259 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $1,167 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,328 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $66 | | Insurance broker organization code? | 3 | | Insurance broker name | OLD KENTUCKY INSURANCE, INC. |
|
| TIME INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69477 ) |
| Policy contract number | M10104 |
| Policy instance | 4 |
| Insurance contract or identification number | M10104 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $7,027 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,373 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,027 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLISON LUCKETT - OLD KENTUCKY INS |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | MG 19802 |
| Policy instance | 1 |
| Insurance contract or identification number | MG 19802 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $244 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $244 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC |
|
| TDC - HUMANA (National Association of Insurance Commissioners NAIC id number: 07566 ) |
| Policy contract number | 5253760 |
| Policy instance | 3 |
| Insurance contract or identification number | 5253760 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $7,928 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $144,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,928 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST, INC. |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 041-6713-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 041-6713-00 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $185 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,066 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $185 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST, INC. |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | MG 19802 |
| Policy instance | 1 |
| Insurance contract or identification number | MG 19802 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $635 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 041-6713-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 041-6713-00 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $501 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TDC - HUMANA (National Association of Insurance Commissioners NAIC id number: 07566 ) |
| Policy contract number | 5253760 |
| Policy instance | 3 |
| Insurance contract or identification number | 5253760 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $6,643 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $120,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | MG 19802 |
| Policy instance | 1 |
| Insurance contract or identification number | MG 19802 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $780 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 041-6713-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 041-6713-00 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $754 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TDC - HUMANA (National Association of Insurance Commissioners NAIC id number: 07566 ) |
| Policy contract number | 5253760 |
| Policy instance | 3 |
| Insurance contract or identification number | 5253760 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $11,438 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $207,970 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
