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DIANNA, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameDIANNA, INC. WELFARE BENEFIT PLAN
Plan identification number 501

DIANNA, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

DIANNA ROSBOROUGH has sponsored the creation of one or more 401k plans.

Company Name:DIANNA ROSBOROUGH
Employer identification number (EIN):680667117
NAIC Classification:541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DIANNA, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-12-01
5012014-12-01
5012013-12-01DIANNA ROSBOROUGH
5012011-12-01DIANNA ROSBOROUGH
5012010-12-01DIANNA ROSBOROUGH

Plan Statistics for DIANNA, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for DIANNA, INC. WELFARE BENEFIT PLAN

Measure Date Value
2015: DIANNA, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-011
Total number of active participants reported on line 7a of the Form 55002015-12-010
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-010
2014: DIANNA, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-011
Total number of active participants reported on line 7a of the Form 55002014-12-011
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-010
Total of all active and inactive participants2014-12-011
2013: DIANNA, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-011
Total number of active participants reported on line 7a of the Form 55002013-12-011
Number of retired or separated participants receiving benefits2013-12-010
Number of other retired or separated participants entitled to future benefits2013-12-010
Total of all active and inactive participants2013-12-011
2011: DIANNA, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-011
Total number of active participants reported on line 7a of the Form 55002011-12-011
Number of retired or separated participants receiving benefits2011-12-010
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-011
2010: DIANNA, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-12-011
Total number of active participants reported on line 7a of the Form 55002010-12-011
Number of retired or separated participants receiving benefits2010-12-010
Number of other retired or separated participants entitled to future benefits2010-12-010
Total of all active and inactive participants2010-12-011

Financial Data on DIANNA, INC. WELFARE BENEFIT PLAN

Measure Date Value
2016 : DIANNA, INC. WELFARE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-01-12$0
Total plan liabilities at beginning of year2016-01-12$3,175
Total income from all sources2016-01-12$0
Expenses. Total of all expenses incurred2016-01-12$0
Total plan assets at end of year2016-01-12$0
Total plan assets at beginning of year2016-01-12$3,175
Net income (gross income less expenses)2016-01-12$0
Net plan assets at end of year (total assets less liabilities)2016-01-12$0
Net plan assets at beginning of year (total assets less liabilities)2016-01-12$0
2015 : DIANNA, INC. WELFARE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-11-30$3,175
Total plan liabilities at beginning of year2015-11-30$3,175
Total income from all sources2015-11-30$0
Expenses. Total of all expenses incurred2015-11-30$0
Total plan assets at end of year2015-11-30$3,175
Total plan assets at beginning of year2015-11-30$3,175
Net income (gross income less expenses)2015-11-30$0
Net plan assets at end of year (total assets less liabilities)2015-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2015-11-30$0
2014 : DIANNA, INC. WELFARE BENEFIT PLAN 2014 401k financial data
Total plan liabilities at end of year2014-11-30$3,175
Total plan liabilities at beginning of year2014-11-30$2,990
Total income from all sources2014-11-30$0
Expenses. Total of all expenses incurred2014-11-30$0
Total plan assets at end of year2014-11-30$3,175
Total plan assets at beginning of year2014-11-30$2,990
Net income (gross income less expenses)2014-11-30$0
Net plan assets at end of year (total assets less liabilities)2014-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2014-11-30$0
2012 : DIANNA, INC. WELFARE BENEFIT PLAN 2012 401k financial data
Total plan liabilities at end of year2012-11-30$2,990
Total plan liabilities at beginning of year2012-11-30$2,918
Total income from all sources2012-11-30$1,330
Expenses. Total of all expenses incurred2012-11-30$1,330
Total plan assets at end of year2012-11-30$2,990
Total plan assets at beginning of year2012-11-30$2,918
Net income (gross income less expenses)2012-11-30$0
Net plan assets at end of year (total assets less liabilities)2012-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2012-11-30$0
Total contributions received or receivable from employer(s)2012-11-30$1,330
Expenses. Administrative service providers (salaries,fees and commissions)2012-11-30$1,330
2011 : DIANNA, INC. WELFARE BENEFIT PLAN 2011 401k financial data
Total plan liabilities at end of year2011-11-30$2,918
Total plan liabilities at beginning of year2011-11-30$0
Total income from all sources2011-11-30$55,510
Expenses. Total of all expenses incurred2011-11-30$55,510
Total plan assets at end of year2011-11-30$2,918
Total plan assets at beginning of year2011-11-30$0
Expenses. Other expenses not covered elsewhere2011-11-30$53,010
Net income (gross income less expenses)2011-11-30$0
Net plan assets at end of year (total assets less liabilities)2011-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2011-11-30$0
Total contributions received or receivable from employer(s)2011-11-30$55,510
Expenses. Administrative service providers (salaries,fees and commissions)2011-11-30$2,500

Form 5500 Responses for DIANNA, INC. WELFARE BENEFIT PLAN

2015: DIANNA, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingYes
2015-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes
2014: DIANNA, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement - TrustYes
2013: DIANNA, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan funding arrangement – TrustYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement - TrustYes
2011: DIANNA, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan funding arrangement – TrustYes
2011-12-01Plan benefit arrangement – InsuranceYes
2011-12-01Plan benefit arrangement - TrustYes
2010: DIANNA, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-12-01Type of plan entitySingle employer plan
2010-12-01First time form 5500 has been submittedYes
2010-12-01Submission has been amendedNo
2010-12-01This submission is the final filingNo
2010-12-01This return/report is a short plan year return/report (less than 12 months)No
2010-12-01Plan is a collectively bargained planNo
2010-12-01Plan funding arrangement – InsuranceYes
2010-12-01Plan funding arrangement – TrustYes
2010-12-01Plan benefit arrangement – InsuranceYes
2010-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5861
Policy instance 1
Insurance contract or identification numberFA-566-5861
Number of Individuals Covered1
Insurance policy start date2015-12-01
Insurance policy end date2016-01-12
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitYes
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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameCJA & ASSOCIATES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5861
Policy instance 1
Insurance contract or identification numberFA-566-5861
Number of Individuals Covered1
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitYes
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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameCJA & ASSOCIATES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5861
Policy instance 1
Insurance contract or identification numberFA-566-5861
Number of Individuals Covered1
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitYes
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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameCJA & ASSOCIATES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5861
Policy instance 1
Insurance contract or identification numberFA-566-5861
Number of Individuals Covered1
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,330
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 BenefitYes
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
Other welfare benefits providedANNUITY
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
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number5861
Policy instance 1
Insurance contract or identification number5861
Number of Individuals Covered1
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $21,124
Total amount of fees paid to insurance companyUSD $2,500
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 BenefitYes
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

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