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HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 401k Plan overview

Plan NameHOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN
Plan identification number 001

HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

HOME HEALTH SERVICES OF TEXAS, INC. has sponsored the creation of one or more 401k plans.

Company Name:HOME HEALTH SERVICES OF TEXAS, INC.
Employer identification number (EIN):201314899
NAIC Classification:621610
NAIC Description:Home Health Care Services

Additional information about HOME HEALTH SERVICES OF TEXAS, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2004-05-24
Company Identification Number: 0800345704
Legal Registered Office Address: PO BOX 111159

CARROLLTON
United States of America (USA)
75011

More information about HOME HEALTH SERVICES OF TEXAS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012014-07-01
0012013-07-01LEE SADLER
0012012-07-01LEE SADLER
0012011-07-01LEE SADLER

Plan Statistics for HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN

401k plan membership statisitcs for HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN

Measure Date Value
2014: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01139
Total number of active participants reported on line 7a of the Form 55002014-07-010
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
Total participants2014-07-010
Number of participants with account balances2014-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-010
2013: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01217
Total number of active participants reported on line 7a of the Form 55002013-07-01110
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-0129
Total of all active and inactive participants2013-07-01139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-01139
Number of participants with account balances2013-07-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-010
2012: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01284
Total number of active participants reported on line 7a of the Form 55002012-07-01217
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-01217
Number of participants with account balances2012-07-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-010
2011: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01221
Total number of active participants reported on line 7a of the Form 55002011-07-01210
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-0174
Total of all active and inactive participants2011-07-01284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-01284
Number of participants with account balances2011-07-01100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-010

Financial Data on HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN

Measure Date Value
2014 : HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2014 401k financial data
Total transfer of assets to this plan2014-12-31$0
Total transfer of assets from this plan2014-12-31$0
Total income from all sources (including contributions)2014-12-31$-7,037
Total of all expenses incurred2014-12-31$1,431,538
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,420,643
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$8,180
Value of total assets at end of year2014-12-31$0
Value of total assets at beginning of year2014-12-31$1,438,575
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$10,895
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$39
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2014-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$39
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$8,180
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-1,438,575
Value of net assets at end of year (total assets less liabilities)2014-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$1,438,575
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$1,438,575
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$-15,256
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,420,643
Contract administrator fees2014-12-31$10,895
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31PMB HELIN DONOVAN LLP
Accountancy firm EIN2014-12-31743001153
Total unrealized appreciation/depreciation of assets2014-06-30$0
Total transfer of assets to this plan2014-06-30$0
Total transfer of assets from this plan2014-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total income from all sources (including contributions)2014-06-30$123,248
Total loss/gain on sale of assets2014-06-30$0
Total of all expenses incurred2014-06-30$264,422
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$256,137
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$68,453
Value of total assets at end of year2014-06-30$1,438,575
Value of total assets at beginning of year2014-06-30$1,579,749
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$8,285
Total interest from all sources2014-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$20,051
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2014-06-30$0
Total dividends received from registered investment company shares (eg mutual funds)2014-06-30$20,051
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$500,000
If this is an individual account plan, was there a blackout period2014-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-06-30$0
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$68,453
Other income not declared elsewhere2014-06-30$45
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$-141,174
Value of net assets at end of year (total assets less liabilities)2014-06-30$1,438,575
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$1,579,749
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$1,438,575
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$1,441,820
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-06-30$137,929
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$34,699
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30No
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$256,137
Contract administrator fees2014-06-30$8,285
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30Yes
Opinion of an independent qualified public accountant for this plan2014-06-30Disclaimer
Accountancy firm name2014-06-30PMB HELIN DONOVAN LLP
Accountancy firm EIN2014-06-30743001153
2013 : HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-06-30$92,532
Total unrealized appreciation/depreciation of assets2013-06-30$92,532
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total income from all sources (including contributions)2013-06-30$217,157
Total loss/gain on sale of assets2013-06-30$0
Total of all expenses incurred2013-06-30$176,651
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$168,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$81,057
Value of total assets at end of year2013-06-30$1,579,749
Value of total assets at beginning of year2013-06-30$1,539,243
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$8,436
Total interest from all sources2013-06-30$43,568
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$500,000
If this is an individual account plan, was there a blackout period2013-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-06-30$0
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$81,057
Participant contributions at beginning of year2013-06-30$145,347
Participant contributions at beginning of year2013-06-30$7,879
Administrative expenses (other) incurred2013-06-30$8,436
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$40,506
Value of net assets at end of year (total assets less liabilities)2013-06-30$1,579,749
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$1,539,243
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-06-30$1,441,820
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$1,368,206
Interest earned on other investments2013-06-30$43,568
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-06-30$137,929
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-06-30$17,811
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30No
Was there a failure to transmit to the plan any participant contributions2013-06-30Yes
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$168,215
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30Yes
Opinion of an independent qualified public accountant for this plan2013-06-30Disclaimer
Accountancy firm name2013-06-30CLIFTON LARSON ALLEN LLP
Accountancy firm EIN2013-06-30410746749
2012 : HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-06-30$-43,569
Total unrealized appreciation/depreciation of assets2012-06-30$-43,569
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$0
Total income from all sources (including contributions)2012-06-30$112,161
Total loss/gain on sale of assets2012-06-30$0
Total of all expenses incurred2012-06-30$1,116,910
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$1,108,731
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$105,286
Value of total assets at end of year2012-06-30$1,539,243
Value of total assets at beginning of year2012-06-30$2,543,992
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$8,179
Total interest from all sources2012-06-30$50,444
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$500,000
If this is an individual account plan, was there a blackout period2012-06-30Yes
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$104,733
Participant contributions at end of year2012-06-30$145,347
Participant contributions at beginning of year2012-06-30$142,153
Participant contributions at end of year2012-06-30$7,879
Participant contributions at beginning of year2012-06-30$3,491
Income. Received or receivable in cash from other sources (including rollovers)2012-06-30$553
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$-1,004,749
Value of net assets at end of year (total assets less liabilities)2012-06-30$1,539,243
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$2,543,992
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-06-30$1,368,206
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-06-30$1,485,356
Interest earned on other investments2012-06-30$50,444
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-06-30$17,811
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-06-30$912,992
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30No
Was there a failure to transmit to the plan any participant contributions2012-06-30Yes
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$1,108,731
Contract administrator fees2012-06-30$8,179
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-06-30Yes
Did the plan have assets held for investment2012-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30Yes
Opinion of an independent qualified public accountant for this plan2012-06-30Disclaimer
Accountancy firm name2012-06-30LARSONALLEN LLP
Accountancy firm EIN2012-06-30410746749

Form 5500 Responses for HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN

2014: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingYes
2014-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: HOME HEALTH SERVICES OF TEXAS, INC. AND AFFILIATED ORGANIZATIONS RETIREMENT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered0
Insurance policy start date2014-07-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameCOSTNER, KATHY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered42
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $3,516
Total amount of fees paid to insurance companyUSD $2,419
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,516
Amount paid for insurance broker fees804
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameVERISIGHT INC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $10,414
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $10,414
Insurance broker organization code?3
Insurance broker nameCOSTNER, KATHY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered175
Insurance policy start date2011-08-15
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $10,414
Total amount of fees paid to insurance companyUSD $3,467
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number44308
Policy instance 2
Insurance contract or identification number44308
Number of Individuals Covered17
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $67
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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