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IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 401k Plan overview

Plan NameIMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN
Plan identification number 503

IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover

401k Sponsoring company profile

RADIO HOLLAND USA, INC. has sponsored the creation of one or more 401k plans.

Company Name:RADIO HOLLAND USA, INC.
Employer identification number (EIN):760556409
NAIC Classification:811210
NAIC Description: Electronic and Precision Equipment Repair and Maintenance

Additional information about RADIO HOLLAND USA, INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2813327

More information about RADIO HOLLAND USA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032016-05-01BRANDI PRIGMORE
5032015-05-01BRANDI PRIGMORE
5032014-05-01BRANDI PRIGMORE
5032013-05-01URS RATHGEB
5032012-05-01URS RATHGEB
5032011-05-01LEE SADLER
5032009-05-01ARLENE FOLLETT

Plan Statistics for IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN

401k plan membership statisitcs for IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN

Measure Date Value
2016: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-0186
Total number of active participants reported on line 7a of the Form 55002016-05-0188
Total of all active and inactive participants2016-05-0188
2015: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-0197
Total number of active participants reported on line 7a of the Form 55002015-05-0186
Total of all active and inactive participants2015-05-0186
2014: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01111
Total number of active participants reported on line 7a of the Form 55002014-05-0197
Total of all active and inactive participants2014-05-0197
2013: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01203
Total number of active participants reported on line 7a of the Form 55002013-05-01169
Total of all active and inactive participants2013-05-01169
2012: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01309
Total number of active participants reported on line 7a of the Form 55002012-05-01332
Total of all active and inactive participants2012-05-01332
2011: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01323
Total number of active participants reported on line 7a of the Form 55002011-05-01309
Total of all active and inactive participants2011-05-01309
2009: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01487
Total number of active participants reported on line 7a of the Form 55002009-05-01497
Total of all active and inactive participants2009-05-01497

Financial Data on IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN

Measure Date Value
2017 : IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2017 401k financial data
Total income from all sources (including contributions)2017-04-30$57,947
Total of all expenses incurred2017-04-30$57,947
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-04-30$57,947
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-04-30$57,947
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-04-30No
Was this plan covered by a fidelity bond2017-04-30No
If this is an individual account plan, was there a blackout period2017-04-30No
Were there any nonexempt tranactions with any party-in-interest2017-04-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-04-30No
Value of net income/loss2017-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-04-30No
Were any leases to which the plan was party in default or uncollectible2017-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-04-30$57,947
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-04-30No
Was there a failure to transmit to the plan any participant contributions2017-04-30No
Has the plan failed to provide any benefit when due under the plan2017-04-30No
Contributions received in cash from employer2017-04-30$57,947
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-04-30No
Did the plan have assets held for investment2017-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-04-30No
2016 : IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2016 401k financial data
Total income from all sources (including contributions)2016-04-30$34,049
Total of all expenses incurred2016-04-30$34,049
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-04-30$34,049
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-04-30$34,049
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-04-30No
Was this plan covered by a fidelity bond2016-04-30No
If this is an individual account plan, was there a blackout period2016-04-30No
Were there any nonexempt tranactions with any party-in-interest2016-04-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-04-30No
Value of net income/loss2016-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-04-30No
Were any leases to which the plan was party in default or uncollectible2016-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-04-30$34,049
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-04-30No
Was there a failure to transmit to the plan any participant contributions2016-04-30No
Has the plan failed to provide any benefit when due under the plan2016-04-30No
Contributions received in cash from employer2016-04-30$34,049
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-04-30No
Did the plan have assets held for investment2016-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-04-30No
2015 : IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2015 401k financial data
Total income from all sources (including contributions)2015-04-30$37,191
Total of all expenses incurred2015-04-30$37,191
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-04-30$37,191
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-04-30$37,191
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-04-30No
Was this plan covered by a fidelity bond2015-04-30No
If this is an individual account plan, was there a blackout period2015-04-30No
Were there any nonexempt tranactions with any party-in-interest2015-04-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Value of net income/loss2015-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-04-30No
Were any leases to which the plan was party in default or uncollectible2015-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-04-30$37,191
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-04-30No
Was there a failure to transmit to the plan any participant contributions2015-04-30No
Has the plan failed to provide any benefit when due under the plan2015-04-30No
Contributions received in cash from employer2015-04-30$37,191
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-04-30No
Did the plan have assets held for investment2015-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-04-30No
Opinion of an independent qualified public accountant for this plan2015-04-30Unqualified
Accountancy firm name2015-04-30BENTLEY, BRATCHER & ASSOCIATES, P.C
Accountancy firm EIN2015-04-30202733640
2014 : IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2014 401k financial data
Total income from all sources (including contributions)2014-04-30$40,114
Total of all expenses incurred2014-04-30$40,114
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-04-30$40,114
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-04-30$40,114
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-04-30No
Was this plan covered by a fidelity bond2014-04-30No
If this is an individual account plan, was there a blackout period2014-04-30No
Were there any nonexempt tranactions with any party-in-interest2014-04-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Value of net income/loss2014-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-04-30No
Were any leases to which the plan was party in default or uncollectible2014-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-04-30$40,114
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-04-30No
Was there a failure to transmit to the plan any participant contributions2014-04-30No
Has the plan failed to provide any benefit when due under the plan2014-04-30No
Contributions received in cash from employer2014-04-30$40,114
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-04-30No
Did the plan have assets held for investment2014-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-04-30No
Opinion of an independent qualified public accountant for this plan2014-04-30Unqualified
Accountancy firm name2014-04-30BENTLEY, BRATCHER & ASSOCIATES, P.C
Accountancy firm EIN2014-04-30202733640
2013 : IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2013 401k financial data
Total income from all sources (including contributions)2013-04-30$40,225
Total of all expenses incurred2013-04-30$40,225
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-04-30$40,225
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-04-30$40,225
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-04-30No
Was this plan covered by a fidelity bond2013-04-30No
If this is an individual account plan, was there a blackout period2013-04-30No
Were there any nonexempt tranactions with any party-in-interest2013-04-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Value of net income/loss2013-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-04-30No
Were any leases to which the plan was party in default or uncollectible2013-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2013-04-30$40,225
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-04-30No
Was there a failure to transmit to the plan any participant contributions2013-04-30No
Has the plan failed to provide any benefit when due under the plan2013-04-30No
Contributions received in cash from employer2013-04-30$40,225
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-04-30No
Did the plan have assets held for investment2013-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-04-30No
Opinion of an independent qualified public accountant for this plan2013-04-30Unqualified
Accountancy firm name2013-04-30BENTLEY, BRATCHER & ASSOCIATES, P.C
Accountancy firm EIN2013-04-30202733640
2012 : IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-04-30$39,633
Total of all expenses incurred2012-04-30$39,633
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-04-30$39,633
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-04-30$39,633
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-04-30No
Was this plan covered by a fidelity bond2012-04-30No
If this is an individual account plan, was there a blackout period2012-04-30No
Were there any nonexempt tranactions with any party-in-interest2012-04-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Value of net income/loss2012-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-04-30No
Were any leases to which the plan was party in default or uncollectible2012-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2012-04-30$39,633
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-04-30No
Was there a failure to transmit to the plan any participant contributions2012-04-30No
Has the plan failed to provide any benefit when due under the plan2012-04-30No
Contributions received in cash from employer2012-04-30$39,633
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-04-30No
Did the plan have assets held for investment2012-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-04-30No
Opinion of an independent qualified public accountant for this plan2012-04-30Unqualified
Accountancy firm name2012-04-30BENTLEY, BRATCHER & ASSOCIATES, P.C
Accountancy firm EIN2012-04-30202733640
2011 : IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-04-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-04-30$0
Total income from all sources (including contributions)2011-04-30$40,716
Total of all expenses incurred2011-04-30$40,716
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-04-30$40,716
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-04-30$40,716
Value of total assets at end of year2011-04-30$0
Value of total assets at beginning of year2011-04-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-04-30No
Was this plan covered by a fidelity bond2011-04-30No
If this is an individual account plan, was there a blackout period2011-04-30No
Were there any nonexempt tranactions with any party-in-interest2011-04-30No
Total non interest bearing cash at end of year2011-04-30$0
Total non interest bearing cash at beginning of year2011-04-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Value of net income/loss2011-04-30$0
Value of net assets at end of year (total assets less liabilities)2011-04-30$0
Value of net assets at beginning of year (total assets less liabilities)2011-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-04-30No
Were any leases to which the plan was party in default or uncollectible2011-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2011-04-30$40,716
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-04-30No
Was there a failure to transmit to the plan any participant contributions2011-04-30No
Has the plan failed to provide any benefit when due under the plan2011-04-30No
Contributions received in cash from employer2011-04-30$40,716
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-04-30No
Liabilities. Value of benefit claims payable at end of year2011-04-30$0
Liabilities. Value of benefit claims payable at beginning of year2011-04-30$0
Did the plan have assets held for investment2011-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-04-30No
Opinion of an independent qualified public accountant for this plan2011-04-30Unqualified
Accountancy firm name2011-04-30BENTLEY, BRATCHER & ASSOCIATES, P.C
Accountancy firm EIN2011-04-30202733640

Form 5500 Responses for IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN

2016: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2009: IMTECH MARINE USA, INC. LIFE & DISABILITY WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01This submission is the final filingNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFY4
Policy instance 1
Insurance contract or identification numberG000AFY4
Number of Individuals Covered86
Insurance policy start date2015-05-01
Insurance policy end date2016-05-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,539
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4539
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD AND OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBOWEN, MICLETTE & BRITT, INS AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFY4
Policy instance 1
Insurance contract or identification numberG000AFY4
Number of Individuals Covered97
Insurance policy start date2014-05-01
Insurance policy end date2015-05-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,539
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4539
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD AND OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBOWEN, MICLETTE & BRITT, INS AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFY4
Policy instance 1
Insurance contract or identification numberG000AFY4
Number of Individuals Covered111
Insurance policy start date2013-05-01
Insurance policy end date2014-05-01
Total amount of commissions paid to insurance brokerUSD $4,876
Total amount of fees paid to insurance companyUSD $943
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,876
Amount paid for insurance broker fees943
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD AND OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBOWEN MICLETTE AND BRITT INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFY4
Policy instance 1
Insurance contract or identification numberG000AFY4
Number of Individuals Covered258
Insurance policy start date2012-05-01
Insurance policy end date2013-05-01
Total amount of commissions paid to insurance brokerUSD $4,877
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,877
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameBOWEN MICLETTE AND BRITT INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFY4
Policy instance 1
Insurance contract or identification numberG000AFY4
Number of Individuals Covered230
Insurance policy start date2011-05-01
Insurance policy end date2012-05-01
Total amount of commissions paid to insurance brokerUSD $4,793
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFY4
Policy instance 1
Insurance contract or identification numberG000AFY4
Number of Individuals Covered240
Insurance policy start date2010-05-01
Insurance policy end date2011-05-01
Total amount of commissions paid to insurance brokerUSD $5,932
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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