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MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameMAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST
Plan identification number 002

MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • 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.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

MAGNOLIA INSURANCE AGENCY, INC. has sponsored the creation of one or more 401k plans.

Company Name:MAGNOLIA INSURANCE AGENCY, INC.
Employer identification number (EIN):710112256
NAIC Classification:524210
NAIC Description:Insurance Agencies and Brokerages

Additional information about MAGNOLIA INSURANCE AGENCY, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 1971-11-03
Company Identification Number: 600056937
Legal Registered Office Address: 3424 W MCGRAW ST

SEATTLE
United States of America (USA)
981990000

More information about MAGNOLIA INSURANCE AGENCY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022019-01-01CHARLES TRIPP CHARLES TRIPP2019-03-12
0022018-01-01CHARLES TRIPP
0022017-01-01CHARLES TRIPP
0022016-01-01CHARLES TRIPP
0022015-01-01CHARLES TRIPP
0022014-01-01CHARLES TRIPP
0022013-01-01CHARLES TRIPP
0022012-01-01CHARLES TRIPP CHARLES TRIPP2013-01-22
0022011-01-01SUZANNE PLETCHER
0022010-01-01SUZANNE PLETCHER
0022009-01-01SHAN PLETCHER

Plan Statistics for MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST

Measure Date Value
2019: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-011
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Total of all active and inactive participants2019-01-010
Total participants2019-01-010
Number of participants with account balances2019-01-010
2018: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-012
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-011
Total of all active and inactive participants2018-01-011
Total participants2018-01-011
Number of participants with account balances2018-01-011
2017: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-012
Total number of active participants reported on line 7a of the Form 55002017-01-011
Number of retired or separated participants receiving benefits2017-01-011
Total of all active and inactive participants2017-01-012
Total participants2017-01-012
Number of participants with account balances2017-01-012
2016: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-013
Total number of active participants reported on line 7a of the Form 55002016-01-011
Number of retired or separated participants receiving benefits2016-01-011
Total of all active and inactive participants2016-01-012
Total participants2016-01-012
Number of participants with account balances2016-01-012
2015: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-013
Total number of active participants reported on line 7a of the Form 55002015-01-012
Number of retired or separated participants receiving benefits2015-01-011
Total of all active and inactive participants2015-01-013
Total participants2015-01-013
Number of participants with account balances2015-01-013
2014: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-013
Total number of active participants reported on line 7a of the Form 55002014-01-012
Number of retired or separated participants receiving benefits2014-01-011
Total of all active and inactive participants2014-01-013
Total participants2014-01-013
Number of participants with account balances2014-01-013
2013: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-013
Total number of active participants reported on line 7a of the Form 55002013-01-013
Total of all active and inactive participants2013-01-013
Total participants2013-01-013
Number of participants with account balances2013-01-013
2012: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-013
Total number of active participants reported on line 7a of the Form 55002012-01-013
Total of all active and inactive participants2012-01-013
Total participants2012-01-013
Number of participants with account balances2012-01-013
2011: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-013
Total number of active participants reported on line 7a of the Form 55002011-01-013
Total of all active and inactive participants2011-01-013
Total participants2011-01-013
Number of participants with account balances2011-01-013
2010: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-013
Total number of active participants reported on line 7a of the Form 55002010-01-012
Number of retired or separated participants receiving benefits2010-01-011
Total of all active and inactive participants2010-01-013
Total participants2010-01-013
Number of participants with account balances2010-01-013
2009: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-014
Total number of active participants reported on line 7a of the Form 55002009-01-012
Number of retired or separated participants receiving benefits2009-01-011
Total of all active and inactive participants2009-01-013
Total participants2009-01-013

Financial Data on MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST

Measure Date Value
2019 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2019 401k financial data
Total income from all sources2019-02-28$47,174
Expenses. Total of all expenses incurred2019-02-28$951,829
Benefits paid (including direct rollovers)2019-02-28$951,829
Total plan assets at end of year2019-02-28$0
Total plan assets at beginning of year2019-02-28$904,655
Value of fidelity bond covering the plan2019-02-28$500,000
Other income received2019-02-28$47,174
Net income (gross income less expenses)2019-02-28$-904,655
Net plan assets at end of year (total assets less liabilities)2019-02-28$0
Net plan assets at beginning of year (total assets less liabilities)2019-02-28$904,655
Assets. Value of real-estate (other than employer real property)2019-02-28$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-02-28$30,591
2018 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2018 401k financial data
Total income from all sources2018-12-31$-85,706
Expenses. Total of all expenses incurred2018-12-31$86,696
Benefits paid (including direct rollovers)2018-12-31$86,696
Total plan assets at end of year2018-12-31$904,655
Total plan assets at beginning of year2018-12-31$1,077,057
Value of fidelity bond covering the plan2018-12-31$500,000
Other income received2018-12-31$-85,706
Net income (gross income less expenses)2018-12-31$-172,402
Net plan assets at end of year (total assets less liabilities)2018-12-31$904,655
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$1,077,057
Assets. Value of real-estate (other than employer real property)2018-12-31$61,182
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$30,591
2017 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total income from all sources2017-12-31$161,631
Expenses. Total of all expenses incurred2017-12-31$44,177
Benefits paid (including direct rollovers)2017-12-31$41,584
Total plan assets at end of year2017-12-31$1,077,057
Total plan assets at beginning of year2017-12-31$959,603
Value of fidelity bond covering the plan2017-12-31$500,000
Expenses. Other expenses not covered elsewhere2017-12-31$1,329
Other income received2017-12-31$161,631
Net income (gross income less expenses)2017-12-31$117,454
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,077,057
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$959,603
Assets. Value of participant loans2017-12-31$1,139
Assets. Value of real-estate (other than employer real property)2017-12-31$61,182
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$1,264
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$36,585
2016 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2016 401k financial data
Total income from all sources2016-12-31$89,345
Expenses. Total of all expenses incurred2016-12-31$209,732
Benefits paid (including direct rollovers)2016-12-31$203,351
Total plan assets at end of year2016-12-31$959,603
Total plan assets at beginning of year2016-12-31$1,079,990
Value of fidelity bond covering the plan2016-12-31$500,000
Expenses. Other expenses not covered elsewhere2016-12-31$5,104
Other income received2016-12-31$89,345
Net income (gross income less expenses)2016-12-31$-120,387
Net plan assets at end of year (total assets less liabilities)2016-12-31$959,603
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,079,990
Assets. Value of participant loans2016-12-31$2,622
Assets. Value of real-estate (other than employer real property)2016-12-31$69,536
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$1,277
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$118,500
2015 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-12-31$25,849
Expenses. Total of all expenses incurred2015-12-31$203,403
Benefits paid (including direct rollovers)2015-12-31$189,500
Total plan assets at end of year2015-12-31$1,079,990
Total plan assets at beginning of year2015-12-31$1,257,544
Value of fidelity bond covering the plan2015-12-31$500,000
Expenses. Other expenses not covered elsewhere2015-12-31$13,903
Other income received2015-12-31$25,849
Net income (gross income less expenses)2015-12-31$-177,554
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,079,990
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,257,544
Assets. Value of participant loans2015-12-31$3,917
Assets. Value of real-estate (other than employer real property)2015-12-31$69,536
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$114,500
2014 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-12-31$89,706
Expenses. Total of all expenses incurred2014-12-31$83,864
Benefits paid (including direct rollovers)2014-12-31$76,000
Total plan assets at end of year2014-12-31$1,257,544
Total plan assets at beginning of year2014-12-31$1,251,702
Value of fidelity bond covering the plan2014-12-31$500,000
Expenses. Other expenses not covered elsewhere2014-12-31$7,864
Other income received2014-12-31$89,706
Net income (gross income less expenses)2014-12-31$5,842
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,257,544
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,251,702
Assets. Value of real-estate (other than employer real property)2014-12-31$69,536
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$26,000
2013 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total income from all sources2013-12-31$146,517
Expenses. Total of all expenses incurred2013-12-31$76,000
Benefits paid (including direct rollovers)2013-12-31$76,000
Total plan assets at end of year2013-12-31$1,251,702
Total plan assets at beginning of year2013-12-31$1,181,185
Value of fidelity bond covering the plan2013-12-31$500,000
Other income received2013-12-31$146,517
Net income (gross income less expenses)2013-12-31$70,517
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,251,702
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,181,185
Assets. Value of real-estate (other than employer real property)2013-12-31$95,536
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$26,000
2012 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Total income from all sources2012-12-31$144,705
Expenses. Total of all expenses incurred2012-12-31$30,000
Benefits paid (including direct rollovers)2012-12-31$30,000
Total plan assets at end of year2012-12-31$1,181,185
Total plan assets at beginning of year2012-12-31$1,066,480
Value of fidelity bond covering the plan2012-12-31$500,000
Other income received2012-12-31$144,705
Net income (gross income less expenses)2012-12-31$114,705
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,181,185
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,066,480
Assets. Value of real-estate (other than employer real property)2012-12-31$121,536
2011 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Total income from all sources2011-12-31$31,054
Expenses. Total of all expenses incurred2011-12-31$25,000
Benefits paid (including direct rollovers)2011-12-31$25,000
Total plan assets at end of year2011-12-31$1,066,480
Total plan assets at beginning of year2011-12-31$1,060,426
Value of fidelity bond covering the plan2011-12-31$265,000
Other income received2011-12-31$31,054
Net income (gross income less expenses)2011-12-31$6,054
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,066,480
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,060,426
Assets. Value of real-estate (other than employer real property)2011-12-31$121,536
2010 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Total income from all sources2010-12-31$66,055
Expenses. Total of all expenses incurred2010-12-31$20,000
Benefits paid (including direct rollovers)2010-12-31$20,000
Total plan assets at end of year2010-12-31$1,060,426
Total plan assets at beginning of year2010-12-31$1,014,371
Value of fidelity bond covering the plan2010-12-31$265,000
Other income received2010-12-31$66,055
Net income (gross income less expenses)2010-12-31$46,055
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,060,426
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,014,371
Assets. Value of real-estate (other than employer real property)2010-12-31$121,536
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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 MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST

2019: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingYes
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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 – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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 – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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 – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 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: MAGNOLIA INSURANCE AGENCY, INC. PROFIT SHARING PLAN AND TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
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

AVIVA LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 62898 )
Policy contract number1OUL13879
Policy instance 1
Insurance contract or identification number1OUL13879
Number of Individuals Covered1
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AVIVA LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 62898 )
Policy contract number1OUL13879
Policy instance 1
Insurance contract or identification number1OUL13879
Number of Individuals Covered1
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AVIVA LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 62898 )
Policy contract number1OUL13879
Policy instance 1
Insurance contract or identification number1OUL13879
Number of Individuals Covered1
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AVIVA LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 62898 )
Policy contract number1OUL13879
Policy instance 1
Insurance contract or identification number1OUL13879
Number of Individuals Covered1
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AVIVA LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 62898 )
Policy contract number1OUL13879
Policy instance 1
Insurance contract or identification number1OUL13879
Number of Individuals Covered1
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AVIVA LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 62898 )
Policy contract number1OUL13879
Policy instance 1
Insurance contract or identification number1OUL13879
Number of Individuals Covered1
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30

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