FORGED COMPONENTS, INC. has sponsored the creation of one or more 401k plans.
Additional information about FORGED COMPONENTS, INC.
Submission information for form 5500 for 401k plan FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST
401k plan membership statisitcs for FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST
| Measure | Date | Value |
|---|
| 2018 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2018 401k financial data |
|---|
| Total income from all sources | 2018-08-31 | $-17,370 |
| Expenses. Total of all expenses incurred | 2018-08-31 | $75 |
| Benefits paid (including direct rollovers) | 2018-08-31 | $75 |
| Total plan assets at end of year | 2018-08-31 | $0 |
| Total plan assets at beginning of year | 2018-08-31 | $17,445 |
| Net income (gross income less expenses) | 2018-08-31 | $-17,445 |
| Net plan assets at end of year (total assets less liabilities) | 2018-08-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-08-31 | $17,445 |
| Total contributions received or receivable from employer(s) | 2018-08-31 | $-17,370 |
| 2017 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2017 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2017-08-31 | $252 |
| Total income from all sources | 2017-08-31 | $14,762 |
| Expenses. Total of all expenses incurred | 2017-08-31 | $-2,683 |
| Benefits paid (including direct rollovers) | 2017-08-31 | $-2,683 |
| Total plan assets at end of year | 2017-08-31 | $17,445 |
| Total plan assets at beginning of year | 2017-08-31 | $252 |
| Net income (gross income less expenses) | 2017-08-31 | $17,445 |
| Net plan assets at end of year (total assets less liabilities) | 2017-08-31 | $17,445 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-08-31 | $0 |
| Total contributions received or receivable from employer(s) | 2017-08-31 | $14,762 |
| 2016 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-08-31 | $252 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-08-31 | $538,664 |
| Total income from all sources (including contributions) | 2016-08-31 | $1,035,440 |
| Total of all expenses incurred | 2016-08-31 | $502,561 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-08-31 | $390,242 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-08-31 | $1,035,440 |
| Value of total assets at end of year | 2016-08-31 | $252 |
| Value of total assets at beginning of year | 2016-08-31 | $5,785 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-08-31 | $112,319 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-08-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2016-08-31 | $0 |
| Was this plan covered by a fidelity bond | 2016-08-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-08-31 | No |
| Contributions received from participants | 2016-08-31 | $221,498 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2016-08-31 | $390,242 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-08-31 | $252 |
| Administrative expenses (other) incurred | 2016-08-31 | $112,319 |
| Total non interest bearing cash at beginning of year | 2016-08-31 | $5,785 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-08-31 | No |
| Value of net income/loss | 2016-08-31 | $532,879 |
| Value of net assets at end of year (total assets less liabilities) | 2016-08-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-08-31 | $-532,879 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-08-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-08-31 | No |
| Contributions received in cash from employer | 2016-08-31 | $813,942 |
| Employer contributions (assets) at end of year | 2016-08-31 | $252 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-08-31 | $538,664 |
| Did the plan have assets held for investment | 2016-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-08-31 | Unqualified |
| Accountancy firm name | 2016-08-31 | MOORE, REICHL & BAKER PC |
| Accountancy firm EIN | 2016-08-31 | 760520230 |
| 2015 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-08-31 | $538,664 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-08-31 | $208,874 |
| Total income from all sources (including contributions) | 2015-08-31 | $3,199,143 |
| Total of all expenses incurred | 2015-08-31 | $3,524,103 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-08-31 | $3,381,695 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-08-31 | $3,199,143 |
| Value of total assets at end of year | 2015-08-31 | $5,785 |
| Value of total assets at beginning of year | 2015-08-31 | $955 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-08-31 | $142,408 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-08-31 | No |
| Was this plan covered by a fidelity bond | 2015-08-31 | Yes |
| Value of fidelity bond cover | 2015-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-08-31 | No |
| Contributions received from participants | 2015-08-31 | $449,217 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-08-31 | $3,381,695 |
| Administrative expenses (other) incurred | 2015-08-31 | $142,408 |
| Total non interest bearing cash at end of year | 2015-08-31 | $5,785 |
| Total non interest bearing cash at beginning of year | 2015-08-31 | $955 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-08-31 | No |
| Value of net income/loss | 2015-08-31 | $-324,960 |
| Value of net assets at end of year (total assets less liabilities) | 2015-08-31 | $-532,879 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-08-31 | $-207,919 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-08-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-08-31 | No |
| Contributions received in cash from employer | 2015-08-31 | $2,749,926 |
| Liabilities. Value of benefit claims payable at end of year | 2015-08-31 | $538,664 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-08-31 | $208,874 |
| Did the plan have assets held for investment | 2015-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-08-31 | Unqualified |
| Accountancy firm name | 2015-08-31 | MOORE, REICHL & BAKER PC |
| Accountancy firm EIN | 2015-08-31 | 760520230 |
| 2014 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-08-31 | $208,874 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-08-31 | $103,615 |
| Total income from all sources (including contributions) | 2014-08-31 | $1,936,296 |
| Total of all expenses incurred | 2014-08-31 | $2,040,713 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-08-31 | $1,891,546 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-08-31 | $1,936,296 |
| Value of total assets at end of year | 2014-08-31 | $955 |
| Value of total assets at beginning of year | 2014-08-31 | $113 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-08-31 | $149,167 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-08-31 | No |
| Was this plan covered by a fidelity bond | 2014-08-31 | Yes |
| Value of fidelity bond cover | 2014-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-08-31 | No |
| Contributions received from participants | 2014-08-31 | $367,803 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-08-31 | $1,891,546 |
| Administrative expenses (other) incurred | 2014-08-31 | $149,167 |
| Total non interest bearing cash at end of year | 2014-08-31 | $955 |
| Total non interest bearing cash at beginning of year | 2014-08-31 | $113 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-08-31 | No |
| Value of net income/loss | 2014-08-31 | $-104,417 |
| Value of net assets at end of year (total assets less liabilities) | 2014-08-31 | $-207,919 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-08-31 | $-103,502 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-08-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-08-31 | No |
| Contributions received in cash from employer | 2014-08-31 | $1,568,493 |
| Liabilities. Value of benefit claims payable at end of year | 2014-08-31 | $208,874 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-08-31 | $103,615 |
| Did the plan have assets held for investment | 2014-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-08-31 | Unqualified |
| Accountancy firm name | 2014-08-31 | MOORE, REICHL & BAKER PC |
| Accountancy firm EIN | 2014-08-31 | 760520230 |
| 2013 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-08-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-08-31 | $103,615 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-08-31 | $109,879 |
| Total income from all sources (including contributions) | 2013-08-31 | $963,117 |
| Total loss/gain on sale of assets | 2013-08-31 | $0 |
| Total of all expenses incurred | 2013-08-31 | $964,309 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-08-31 | $858,746 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-08-31 | $963,117 |
| Value of total assets at end of year | 2013-08-31 | $113 |
| Value of total assets at beginning of year | 2013-08-31 | $7,569 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-08-31 | $105,563 |
| Total interest from all sources | 2013-08-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-08-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-08-31 | No |
| Was this plan covered by a fidelity bond | 2013-08-31 | Yes |
| Value of fidelity bond cover | 2013-08-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-08-31 | No |
| Contributions received from participants | 2013-08-31 | $257,981 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-08-31 | $858,746 |
| Administrative expenses (other) incurred | 2013-08-31 | $105,563 |
| Total non interest bearing cash at end of year | 2013-08-31 | $113 |
| Total non interest bearing cash at beginning of year | 2013-08-31 | $7,569 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-08-31 | No |
| Value of net income/loss | 2013-08-31 | $-1,192 |
| Value of net assets at end of year (total assets less liabilities) | 2013-08-31 | $-103,502 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-08-31 | $-102,310 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-08-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-08-31 | No |
| Contributions received in cash from employer | 2013-08-31 | $705,136 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-08-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-08-31 | $103,615 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-08-31 | $109,879 |
| Did the plan have assets held for investment | 2013-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-08-31 | Unqualified |
| Accountancy firm name | 2013-08-31 | MOORE, REICHL & BAKER PC |
| Accountancy firm EIN | 2013-08-31 | 760520230 |
| 2012 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $109,879 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $88,351 |
| Total income from all sources (including contributions) | 2012-08-31 | $125,143 |
| Total of all expenses incurred | 2012-08-31 | $174,227 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-08-31 | $151,314 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-08-31 | $125,143 |
| Value of total assets at end of year | 2012-08-31 | $7,569 |
| Value of total assets at beginning of year | 2012-08-31 | $35,125 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-08-31 | $22,913 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-08-31 | No |
| Was this plan covered by a fidelity bond | 2012-08-31 | No |
| If this is an individual account plan, was there a blackout period | 2012-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-08-31 | No |
| Contributions received from participants | 2012-08-31 | $54,108 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-08-31 | $151,314 |
| Administrative expenses (other) incurred | 2012-08-31 | $22,913 |
| Total non interest bearing cash at end of year | 2012-08-31 | $7,569 |
| Total non interest bearing cash at beginning of year | 2012-08-31 | $35,125 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-08-31 | No |
| Value of net income/loss | 2012-08-31 | $-49,084 |
| Value of net assets at end of year (total assets less liabilities) | 2012-08-31 | $-102,310 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-08-31 | $-53,226 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-08-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-08-31 | No |
| Contributions received in cash from employer | 2012-08-31 | $71,035 |
| Liabilities. Value of benefit claims payable at end of year | 2012-08-31 | $109,879 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-08-31 | $88,351 |
| Did the plan have assets held for investment | 2012-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-08-31 | Unqualified |
| Accountancy firm name | 2012-08-31 | MOORE, REICHL & BAKER PC |
| Accountancy firm EIN | 2012-08-31 | 760520230 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $88,351 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $61,525 |
| Total income from all sources (including contributions) | 2012-06-30 | $591,509 |
| Total of all expenses incurred | 2012-06-30 | $583,210 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-06-30 | $480,616 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-06-30 | $591,509 |
| Value of total assets at end of year | 2012-06-30 | $35,125 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-06-30 | $102,594 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-06-30 | No |
| Was this plan covered by a fidelity bond | 2012-06-30 | No |
| If this is an individual account plan, was there a blackout period | 2012-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-06-30 | No |
| Contributions received from participants | 2012-06-30 | $232,486 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-06-30 | $480,616 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-06-30 | $78 |
| Administrative expenses (other) incurred | 2012-06-30 | $102,594 |
| Total non interest bearing cash at end of year | 2012-06-30 | $35,125 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Value of net income/loss | 2012-06-30 | $8,299 |
| Value of net assets at end of year (total assets less liabilities) | 2012-06-30 | $-53,226 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-06-30 | $-61,525 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-06-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-06-30 | No |
| Contributions received in cash from employer | 2012-06-30 | $359,023 |
| Liabilities. Value of benefit claims payable at end of year | 2012-06-30 | $88,351 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-06-30 | $61,447 |
| Did the plan have assets held for investment | 2012-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-06-30 | Unqualified |
| Accountancy firm name | 2012-06-30 | MOORE, REICHL & BAKER PC |
| Accountancy firm EIN | 2012-06-30 | 760520230 |
| 2011 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $61,525 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $53,564 |
| Total income from all sources (including contributions) | 2011-06-30 | $584,918 |
| Total of all expenses incurred | 2011-06-30 | $606,624 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $536,605 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $584,918 |
| Value of total assets at end of year | 2011-06-30 | $0 |
| Value of total assets at beginning of year | 2011-06-30 | $13,745 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $70,019 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Was this plan covered by a fidelity bond | 2011-06-30 | No |
| If this is an individual account plan, was there a blackout period | 2011-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Contributions received from participants | 2011-06-30 | $101,999 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-06-30 | $536,605 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-06-30 | $78 |
| Administrative expenses (other) incurred | 2011-06-30 | $70,019 |
| Total non interest bearing cash at beginning of year | 2011-06-30 | $13,745 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $-21,706 |
| Value of net assets at end of year (total assets less liabilities) | 2011-06-30 | $-61,525 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-06-30 | $-39,819 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $482,919 |
| Liabilities. Value of benefit claims payable at end of year | 2011-06-30 | $61,447 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-06-30 | $53,564 |
| Did the plan have assets held for investment | 2011-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Unqualified |
| Accountancy firm name | 2011-06-30 | MOORE, REICHL & BAKER PC |
| Accountancy firm EIN | 2011-06-30 | 760520230 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 890873G |
| Policy instance | 2 |
| Insurance contract or identification number | 890873G | | Number of Individuals Covered | 270 | | Insurance policy start date | 2023-04-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $13,142 | | Total amount of fees paid to insurance company | USD $742 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $84,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00629494 |
| Policy instance | 1 |
| Insurance contract or identification number | 00629494 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2023-04-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $9,329 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $94,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 0629494 |
| Policy instance | 3 |
| Insurance contract or identification number | 0629494 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $153,879 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $955,682 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $153,879 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | BCM005722 |
| Policy instance | 2 |
| Insurance contract or identification number | BCM005722 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $4,299 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $31,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,299 | | Insurance broker organization code? | 3 |
|
| THE HARTFORD (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 890873G |
| Policy instance | 1 |
| Insurance contract or identification number | 890873G | | Number of Individuals Covered | 262 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $14,874 | | Total amount of fees paid to insurance company | USD $487 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $91,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,874 | | Amount paid for insurance broker fees | 487 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | BCM0055723 |
| Policy instance | 4 |
| Insurance contract or identification number | BCM0055723 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $3,821 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $30,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 0069494 |
| Policy instance | 3 |
| Insurance contract or identification number | 0069494 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $2,600 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $818,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,600 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 890873G |
| Policy instance | 2 |
| Insurance contract or identification number | 890873G | | Number of Individuals Covered | 242 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $15,282 | | Total amount of fees paid to insurance company | USD $166 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $94,455 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,282 | | Amount paid for insurance broker fees | 166 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | BCM005722 |
| Policy instance | 1 |
| Insurance contract or identification number | BCM005722 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $2,044 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | BCM00572-4 |
| Policy instance | 4 |
| Insurance contract or identification number | BCM00572-4 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $6,710 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $67,646 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,710 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 890873G |
| Policy instance | 3 |
| Insurance contract or identification number | 890873G | | Number of Individuals Covered | 247 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $16,060 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $100,415 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,060 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 0629494 |
| Policy instance | 2 |
| Insurance contract or identification number | 0629494 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,234 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $113,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,234 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00629494 |
| Policy instance | 1 |
| Insurance contract or identification number | 00629494 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $142,019 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $730,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $142,019 | | Insurance broker organization code? | 3 |
|
