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CIG INC. 401(K) PLAN 401k Plan overview

Plan NameCIG INC. 401(K) PLAN
Plan identification number 001

CIG INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • 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.
  • 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.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • 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

CONSOLIDATED INFRASTRUCTURE GROUP, INC has sponsored the creation of one or more 401k plans.

Company Name:CONSOLIDATED INFRASTRUCTURE GROUP, INC
Employer identification number (EIN):812496870
NAIC Classification:561900

Additional information about CONSOLIDATED INFRASTRUCTURE GROUP, INC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 6031624

More information about CONSOLIDATED INFRASTRUCTURE GROUP, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CIG INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-01-01MICHAEL JOHNSON2021-10-15
0012020-01-01MICHAEL JOHNSON2021-10-15
0012019-01-01
0012018-01-01
0012017-01-01CRAIG CHRISTIANSON
0012017-01-01
0012016-01-01CRAIG CHRISTIANSON2017-06-28

Plan Statistics for CIG INC. 401(K) PLAN

401k plan membership statisitcs for CIG INC. 401(K) PLAN

Measure Date Value
2019: CIG INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01129
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
Number of other retired or separated participants entitled to future benefits2019-01-0141
Total of all active and inactive participants2019-01-0141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0141
Number of participants with account balances2019-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: CIG INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01723
Total number of active participants reported on line 7a of the Form 55002018-01-0168
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0161
Total of all active and inactive participants2018-01-01129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01129
Number of participants with account balances2018-01-0169
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0151
2017: CIG INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01372
Total number of active participants reported on line 7a of the Form 55002017-01-01664
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-014
Total of all active and inactive participants2017-01-01668
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01668
Number of participants with account balances2017-01-0164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-016

Financial Data on CIG INC. 401(K) PLAN

Measure Date Value
2019 : CIG INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$46,705
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$46,705
Total income from all sources (including contributions)2019-12-31$79,525
Total income from all sources (including contributions)2019-12-31$79,525
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$210,032
Total of all expenses incurred2019-12-31$210,032
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$201,030
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$201,030
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$7,335
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$7,335
Value of total assets at end of year2019-12-31$263,257
Value of total assets at end of year2019-12-31$263,257
Value of total assets at beginning of year2019-12-31$440,469
Value of total assets at beginning of year2019-12-31$440,469
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$9,002
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$9,002
Total interest from all sources2019-12-31$177
Total interest from all sources2019-12-31$177
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$2,375
Administrative expenses professional fees incurred2019-12-31$2,375
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$7,335
Contributions received from participants2019-12-31$7,335
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$46,705
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$46,705
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-130,507
Value of net income/loss2019-12-31$-130,507
Value of net assets at end of year (total assets less liabilities)2019-12-31$263,257
Value of net assets at end of year (total assets less liabilities)2019-12-31$263,257
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$393,764
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$393,764
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$261,250
Value of interest in pooled separate accounts at end of year2019-12-31$261,250
Value of interest in pooled separate accounts at beginning of year2019-12-31$424,270
Value of interest in pooled separate accounts at beginning of year2019-12-31$424,270
Interest earned on other investments2019-12-31$177
Interest earned on other investments2019-12-31$177
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$2,007
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$16,199
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$16,199
Net investment gain/loss from pooled separate accounts2019-12-31$72,013
Net investment gain/loss from pooled separate accounts2019-12-31$72,013
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$201,030
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$201,030
Contract administrator fees2019-12-31$6,627
Contract administrator fees2019-12-31$6,627
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31HBE,LLP
Accountancy firm name2019-12-31HBE,LLP
Accountancy firm EIN2019-12-31470677245
Accountancy firm EIN2019-12-31470677245
2018 : CIG INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$46,705
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$201,326
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$148,148
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$91,522
Value of total corrective distributions2018-12-31$46,705
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$239,832
Value of total assets at end of year2018-12-31$440,469
Value of total assets at beginning of year2018-12-31$340,586
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$9,921
Total interest from all sources2018-12-31$94
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$239,832
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$46,705
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$53,178
Value of net assets at end of year (total assets less liabilities)2018-12-31$393,764
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$340,586
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in pooled separate accounts at end of year2018-12-31$424,270
Value of interest in pooled separate accounts at beginning of year2018-12-31$269,425
Interest on participant loans2018-12-31$0
Income. Interest from loans (other than to participants)2018-12-31$0
Interest earned on other investments2018-12-31$94
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$16,199
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$1,416
Net investment gain/loss from pooled separate accounts2018-12-31$-38,600
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$0
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$69,745
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$91,522
Contract administrator fees2018-12-31$9,921
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31HBE,LLP
Accountancy firm EIN2018-12-31470677245
2017 : CIG INC. 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$332,714
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$28,537
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$22,585
Value of total corrective distributions2017-12-31$5,052
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$312,829
Value of total assets at end of year2017-12-31$340,586
Value of total assets at beginning of year2017-12-31$36,409
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$900
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$196,025
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$33,222
Other income not declared elsewhere2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$304,177
Value of net assets at end of year (total assets less liabilities)2017-12-31$340,586
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$36,409
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in pooled separate accounts at end of year2017-12-31$269,425
Value of interest in pooled separate accounts at beginning of year2017-12-31$36,409
Interest on participant loans2017-12-31$0
Income. Interest from loans (other than to participants)2017-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$1,416
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$0
Net investment gain/loss from pooled separate accounts2017-12-31$19,885
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$83,582
Employer contributions (assets) at end of year2017-12-31$69,745
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$22,585
Contract administrator fees2017-12-31$900
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31HBE,LLC
Accountancy firm EIN2017-12-31470677245

Form 5500 Responses for CIG INC. 401(K) PLAN

2019: CIG INC. 401(K) PLAN 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 filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: CIG INC. 401(K) PLAN 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 – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: CIG INC. 401(K) PLAN 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 – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number21570
Policy instance 1
Insurance contract or identification number21570
Number of Individuals Covered41
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,040
Total amount of fees paid to insurance companyUSD $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 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?Yes
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
Commission paid to Insurance BrokerUSD $1,040
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number812496870
Policy instance 1
Insurance contract or identification number812496870
Number of Individuals Covered69
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,173
Total amount of fees paid to insurance companyUSD $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 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?Yes
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
Commission paid to Insurance BrokerUSD $1,106
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number812496870
Policy instance 1
Insurance contract or identification number812496870
Number of Individuals Covered64
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,454
Total amount of fees paid to insurance companyUSD $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 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?Yes
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
Commission paid to Insurance BrokerUSD $727
Insurance broker organization code?3
Insurance broker nameDUSTIN FORMANACK

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