JASMINE VINEYARDS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN
401k plan membership statisitcs for JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN
| Measure | Date | Value |
|---|
| 2023: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-02-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-02-01 | 143 |
| Number of retired or separated participants receiving benefits | 2023-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-02-01 | 0 |
| Total of all active and inactive participants | 2023-02-01 | 143 |
| Number of employers contributing to the scheme | 2023-02-01 | 0 |
| 2022: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 198 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 205 |
| Number of retired or separated participants receiving benefits | 2022-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
| Total of all active and inactive participants | 2022-02-01 | 205 |
| Number of employers contributing to the scheme | 2022-02-01 | 0 |
| 2021: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 243 |
| Number of retired or separated participants receiving benefits | 2021-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-02-01 | 0 |
| Total of all active and inactive participants | 2021-02-01 | 243 |
| 2020: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 297 |
| Number of retired or separated participants receiving benefits | 2020-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
| Total of all active and inactive participants | 2020-02-01 | 297 |
| 2019: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 297 |
| Number of retired or separated participants receiving benefits | 2019-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-02-01 | 0 |
| Total of all active and inactive participants | 2019-02-01 | 297 |
| 2018: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 278 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 273 |
| Number of retired or separated participants receiving benefits | 2018-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 0 |
| Total of all active and inactive participants | 2018-02-01 | 273 |
| 2017: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 301 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 292 |
| Number of retired or separated participants receiving benefits | 2017-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-02-01 | 0 |
| Total of all active and inactive participants | 2017-02-01 | 292 |
| 2016: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 536 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 301 |
| Number of retired or separated participants receiving benefits | 2016-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-02-01 | 0 |
| Total of all active and inactive participants | 2016-02-01 | 301 |
| 2015: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 522 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 536 |
| Number of retired or separated participants receiving benefits | 2015-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-02-01 | 0 |
| Total of all active and inactive participants | 2015-02-01 | 536 |
| 2014: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 522 |
| Number of retired or separated participants receiving benefits | 2014-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-02-01 | 0 |
| Total of all active and inactive participants | 2014-02-01 | 522 |
| 2013: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 268 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 60 |
| Number of retired or separated participants receiving benefits | 2013-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-02-01 | 0 |
| Total of all active and inactive participants | 2013-02-01 | 60 |
| 2012: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 265 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 93 |
| Number of retired or separated participants receiving benefits | 2012-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-02-01 | 0 |
| Total of all active and inactive participants | 2012-02-01 | 93 |
| 2011: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 56 |
| Number of retired or separated participants receiving benefits | 2011-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-02-01 | 0 |
| Total of all active and inactive participants | 2011-02-01 | 56 |
| 2009: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 158 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 85 |
| Number of retired or separated participants receiving benefits | 2009-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-02-01 | 0 |
| Total of all active and inactive participants | 2009-02-01 | 85 |
| Measure | Date | Value |
|---|
| 2014 : JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-01-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-01-31 | $94,602 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-01-31 | $174,996 |
| Total income from all sources (including contributions) | 2014-01-31 | $619,199 |
| Total loss/gain on sale of assets | 2014-01-31 | $0 |
| Total of all expenses incurred | 2014-01-31 | $619,320 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-01-31 | $268,156 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-01-31 | $619,199 |
| Value of total assets at end of year | 2014-01-31 | $95,721 |
| Value of total assets at beginning of year | 2014-01-31 | $176,236 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-01-31 | $351,164 |
| Total interest from all sources | 2014-01-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-01-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-01-31 | No |
| Administrative expenses professional fees incurred | 2014-01-31 | $2,050 |
| Was this plan covered by a fidelity bond | 2014-01-31 | Yes |
| Value of fidelity bond cover | 2014-01-31 | $10,000 |
| If this is an individual account plan, was there a blackout period | 2014-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-01-31 | No |
| Contributions received from participants | 2014-01-31 | $2,182 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2014-01-31 | $18,334 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-01-31 | $14,002 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-01-31 | $18,422 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-01-31 | $11,035 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-01-31 | $14,260 |
| Administrative expenses (other) incurred | 2014-01-31 | $255,348 |
| Liabilities. Value of operating payables at end of year | 2014-01-31 | $2,967 |
| Liabilities. Value of operating payables at beginning of year | 2014-01-31 | $4,162 |
| Total non interest bearing cash at end of year | 2014-01-31 | $1,119 |
| Total non interest bearing cash at beginning of year | 2014-01-31 | $1,240 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-01-31 | No |
| Value of net income/loss | 2014-01-31 | $-121 |
| Value of net assets at end of year (total assets less liabilities) | 2014-01-31 | $1,119 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-01-31 | $1,240 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-01-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-01-31 | No |
| Contributions received in cash from employer | 2014-01-31 | $598,683 |
| Employer contributions (assets) at end of year | 2014-01-31 | $80,600 |
| Employer contributions (assets) at beginning of year | 2014-01-31 | $156,574 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-01-31 | $268,156 |
| Contract administrator fees | 2014-01-31 | $93,766 |
| Liabilities. Value of benefit claims payable at end of year | 2014-01-31 | $80,600 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-01-31 | $156,574 |
| Did the plan have assets held for investment | 2014-01-31 | 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 | 2014-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-01-31 | Unqualified |
| Accountancy firm name | 2014-01-31 | STOUGHTON DAVIDSON ACCOUNTANCY |
| Accountancy firm EIN | 2014-01-31 | 942248751 |
| 2013 : JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-01-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-01-31 | $174,996 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-01-31 | $120,272 |
| Total income from all sources (including contributions) | 2013-01-31 | $646,948 |
| Total loss/gain on sale of assets | 2013-01-31 | $0 |
| Total of all expenses incurred | 2013-01-31 | $646,791 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-01-31 | $363,701 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-01-31 | $646,948 |
| Value of total assets at end of year | 2013-01-31 | $176,236 |
| Value of total assets at beginning of year | 2013-01-31 | $121,355 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-01-31 | $283,090 |
| Total interest from all sources | 2013-01-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-01-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-01-31 | No |
| Administrative expenses professional fees incurred | 2013-01-31 | $1,650 |
| Was this plan covered by a fidelity bond | 2013-01-31 | Yes |
| Value of fidelity bond cover | 2013-01-31 | $10,000 |
| If this is an individual account plan, was there a blackout period | 2013-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-01-31 | No |
| Contributions received from participants | 2013-01-31 | $1,656 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-01-31 | $41,691 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-01-31 | $18,422 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-01-31 | $46,582 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-01-31 | $14,260 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-01-31 | $41,590 |
| Administrative expenses (other) incurred | 2013-01-31 | $208,298 |
| Liabilities. Value of operating payables at end of year | 2013-01-31 | $4,162 |
| Liabilities. Value of operating payables at beginning of year | 2013-01-31 | $4,992 |
| Total non interest bearing cash at end of year | 2013-01-31 | $1,240 |
| Total non interest bearing cash at beginning of year | 2013-01-31 | $1,083 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-01-31 | No |
| Value of net income/loss | 2013-01-31 | $157 |
| Value of net assets at end of year (total assets less liabilities) | 2013-01-31 | $1,240 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-01-31 | $1,083 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-01-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-01-31 | No |
| Contributions received in cash from employer | 2013-01-31 | $603,601 |
| Employer contributions (assets) at end of year | 2013-01-31 | $156,574 |
| Employer contributions (assets) at beginning of year | 2013-01-31 | $73,690 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-01-31 | $363,701 |
| Contract administrator fees | 2013-01-31 | $73,142 |
| Liabilities. Value of benefit claims payable at end of year | 2013-01-31 | $156,574 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-01-31 | $73,690 |
| Did the plan have assets held for investment | 2013-01-31 | 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 | 2013-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-01-31 | Unqualified |
| Accountancy firm name | 2013-01-31 | STOUGHTON DAVIDSON ACCOUNTANCY |
| Accountancy firm EIN | 2013-01-31 | 942248751 |
| 2012 : JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-01-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-01-31 | $120,272 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-01-31 | $83,145 |
| Total income from all sources (including contributions) | 2012-01-31 | $495,612 |
| Total loss/gain on sale of assets | 2012-01-31 | $0 |
| Total of all expenses incurred | 2012-01-31 | $502,823 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-01-31 | $274,476 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-01-31 | $495,612 |
| Value of total assets at end of year | 2012-01-31 | $121,355 |
| Value of total assets at beginning of year | 2012-01-31 | $91,439 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-01-31 | $228,347 |
| Total interest from all sources | 2012-01-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-01-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-01-31 | No |
| Administrative expenses professional fees incurred | 2012-01-31 | $1,650 |
| Was this plan covered by a fidelity bond | 2012-01-31 | Yes |
| Value of fidelity bond cover | 2012-01-31 | $10,000 |
| If this is an individual account plan, was there a blackout period | 2012-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-01-31 | No |
| Contributions received from participants | 2012-01-31 | $1,572 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-01-31 | $47,461 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-01-31 | $46,582 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-01-31 | $21,411 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-01-31 | $41,590 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-01-31 | $19,056 |
| Administrative expenses (other) incurred | 2012-01-31 | $166,729 |
| Liabilities. Value of operating payables at end of year | 2012-01-31 | $4,992 |
| Liabilities. Value of operating payables at beginning of year | 2012-01-31 | $2,355 |
| Total non interest bearing cash at end of year | 2012-01-31 | $1,083 |
| Total non interest bearing cash at beginning of year | 2012-01-31 | $8,294 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-01-31 | No |
| Value of net income/loss | 2012-01-31 | $-7,211 |
| Value of net assets at end of year (total assets less liabilities) | 2012-01-31 | $1,083 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-01-31 | $8,294 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-01-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-01-31 | No |
| Contributions received in cash from employer | 2012-01-31 | $446,579 |
| Employer contributions (assets) at end of year | 2012-01-31 | $73,690 |
| Employer contributions (assets) at beginning of year | 2012-01-31 | $61,734 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-01-31 | $274,476 |
| Contract administrator fees | 2012-01-31 | $59,968 |
| Liabilities. Value of benefit claims payable at end of year | 2012-01-31 | $73,690 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-01-31 | $61,734 |
| Did the plan have assets held for investment | 2012-01-31 | 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 | 2012-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-01-31 | Unqualified |
| Accountancy firm name | 2012-01-31 | FOREST MCQUEEN CERTIFIED PUBLIC ACC |
| Accountancy firm EIN | 2012-01-31 | 941724730 |
| 2011 : JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-01-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-01-31 | $83,145 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-01-31 | $45,665 |
| Total income from all sources (including contributions) | 2011-01-31 | $400,366 |
| Total loss/gain on sale of assets | 2011-01-31 | $0 |
| Total of all expenses incurred | 2011-01-31 | $414,055 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-01-31 | $213,249 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-01-31 | $400,366 |
| Value of total assets at end of year | 2011-01-31 | $91,439 |
| Value of total assets at beginning of year | 2011-01-31 | $67,648 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-01-31 | $200,806 |
| Total interest from all sources | 2011-01-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-01-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-01-31 | No |
| Administrative expenses professional fees incurred | 2011-01-31 | $1,650 |
| Was this plan covered by a fidelity bond | 2011-01-31 | Yes |
| Value of fidelity bond cover | 2011-01-31 | $10,000 |
| If this is an individual account plan, was there a blackout period | 2011-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-01-31 | No |
| Contributions received from participants | 2011-01-31 | $2,795 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-01-31 | $25,371 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-01-31 | $21,411 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-01-31 | $23,620 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-01-31 | $19,056 |
| Administrative expenses (other) incurred | 2011-01-31 | $144,838 |
| Liabilities. Value of operating payables at end of year | 2011-01-31 | $2,355 |
| Liabilities. Value of operating payables at beginning of year | 2011-01-31 | $3,521 |
| Total non interest bearing cash at end of year | 2011-01-31 | $8,294 |
| Total non interest bearing cash at beginning of year | 2011-01-31 | $1,884 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-01-31 | No |
| Value of net income/loss | 2011-01-31 | $-13,689 |
| Value of net assets at end of year (total assets less liabilities) | 2011-01-31 | $8,294 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-01-31 | $21,983 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-01-31 | No |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2011-01-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-01-31 | No |
| Contributions received in cash from employer | 2011-01-31 | $372,200 |
| Employer contributions (assets) at end of year | 2011-01-31 | $61,734 |
| Employer contributions (assets) at beginning of year | 2011-01-31 | $42,144 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-01-31 | $213,249 |
| Contract administrator fees | 2011-01-31 | $54,318 |
| Liabilities. Value of benefit claims payable at end of year | 2011-01-31 | $61,734 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-01-31 | $42,144 |
| Did the plan have assets held for investment | 2011-01-31 | 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 | 2011-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-01-31 | Unqualified |
| Accountancy firm name | 2011-01-31 | FOREST MCQUEEN CERTIFIED PUBLIC ACC |
| Accountancy firm EIN | 2011-01-31 | 941724730 |
| 2023: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2023 form 5500 responses |
|---|
| 2023-02-01 | Type of plan entity | Single employer plan |
| 2023-02-01 | Plan funding arrangement – Insurance | Yes |
| 2023-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Submission has been amended | No |
| 2021-02-01 | This submission is the final filing | No |
| 2021-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-02-01 | Plan is a collectively bargained plan | No |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | Submission has been amended | No |
| 2020-02-01 | This submission is the final filing | No |
| 2020-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-02-01 | Plan is a collectively bargained plan | No |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Single employer plan |
| 2019-02-01 | Submission has been amended | No |
| 2019-02-01 | This submission is the final filing | No |
| 2019-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-02-01 | Plan is a collectively bargained plan | No |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | Submission has been amended | No |
| 2018-02-01 | This submission is the final filing | No |
| 2018-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-02-01 | Plan is a collectively bargained plan | No |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Submission has been amended | No |
| 2017-02-01 | This submission is the final filing | No |
| 2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-02-01 | Plan is a collectively bargained plan | No |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Submission has been amended | No |
| 2016-02-01 | This submission is the final filing | No |
| 2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-02-01 | Plan is a collectively bargained plan | No |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Submission has been amended | No |
| 2015-02-01 | This submission is the final filing | No |
| 2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-02-01 | Plan is a collectively bargained plan | No |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Submission has been amended | No |
| 2014-02-01 | This submission is the final filing | No |
| 2014-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-02-01 | Plan is a collectively bargained plan | No |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Submission has been amended | No |
| 2013-02-01 | This submission is the final filing | No |
| 2013-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-02-01 | Plan is a collectively bargained plan | No |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan funding arrangement – Trust | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement - Trust | Yes |
| 2012: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Submission has been amended | No |
| 2012-02-01 | This submission is the final filing | No |
| 2012-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-02-01 | Plan is a collectively bargained plan | No |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan funding arrangement – Trust | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement - Trust | Yes |
| 2011: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Submission has been amended | No |
| 2011-02-01 | This submission is the final filing | No |
| 2011-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-02-01 | Plan is a collectively bargained plan | No |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan funding arrangement – Trust | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement - Trust | Yes |
| 2009: JASMINE VINEYARDS, INC. HEALTH & WELFARE PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Submission has been amended | Yes |
| 2009-02-01 | This submission is the final filing | No |
| 2009-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-02-01 | Plan is a collectively bargained plan | No |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan funding arrangement – Trust | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement - Trust | Yes |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $25,540 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $212,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $38,581 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $321,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,581 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $37,712 | | 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 | 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 $314,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,712 | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $46,285 | | 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 | 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 $385,709 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,285 | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $56,625 | | 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 | 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 $471,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,625 | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $57,170 | | 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 | 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 $476,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,170 | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $76,053 | | 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 | 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 $633,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $76,053 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES G. PARKER INSURANCE |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 | | Number of Individuals Covered | 536 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $79,770 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $664,752 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $79,770 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES G. PARKER INSURANCE |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | SE072 SE072-COB |
| Policy instance | 1 |
| Insurance contract or identification number | SE072 SE072-COB | | Number of Individuals Covered | 522 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $85,000 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $755,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $85,000 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES G. PARKER INSURANCE |
|
| UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 77K2 |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG 77K2 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $6,853 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | | Commission paid to Insurance Broker | USD $5,140 | | Insurance broker organization code? | 0 | | Insurance broker name | JAMES G PARKER & ASSOCIATES |
|
| UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 77K2 |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG 77K2 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $6,014 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | | Commission paid to Insurance Broker | USD $4,511 | | Insurance broker organization code? | 0 | | Insurance broker name | JAMES G PARKER & ASSOCIATES |
|
| UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 77K2 |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG 77K2 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $5,091 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 |
|
| UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG 77K2 |
| Policy instance | 1 |
| Insurance contract or identification number | GLUG 77K2 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $4,117 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 |
|
