J&M MANUFACTURING CO. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN
401k plan membership statisitcs for J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-08-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 168 |
| Number of retired or separated participants receiving benefits | 2022-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 0 |
| Total of all active and inactive participants | 2022-08-01 | 168 |
| Total participants | 2022-08-01 | 168 |
| 2021: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 126 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
| Total of all active and inactive participants | 2021-08-01 | 126 |
| Total participants | 2021-08-01 | 126 |
| 2020: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 126 |
| Number of retired or separated participants receiving benefits | 2020-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 0 |
| Total of all active and inactive participants | 2020-08-01 | 126 |
| Total participants | 2020-08-01 | 126 |
| 2019: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 123 |
| Number of retired or separated participants receiving benefits | 2019-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
| Total of all active and inactive participants | 2019-08-01 | 123 |
| Total participants | 2019-08-01 | 123 |
| 2018: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 127 |
| Number of retired or separated participants receiving benefits | 2018-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
| Total of all active and inactive participants | 2018-08-01 | 127 |
| Total participants | 2018-08-01 | 127 |
| 2017: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 122 |
| Number of retired or separated participants receiving benefits | 2017-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
| Total of all active and inactive participants | 2017-08-01 | 122 |
| Total participants | 2017-08-01 | 122 |
| 2016: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 120 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
| Total of all active and inactive participants | 2016-08-01 | 120 |
| Total participants | 2016-08-01 | 120 |
| 2015: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 117 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
| Total of all active and inactive participants | 2015-08-01 | 117 |
| Total participants | 2015-08-01 | 117 |
| 2014: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 149 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
| Total of all active and inactive participants | 2014-08-01 | 149 |
| Total participants | 2014-08-01 | 149 |
| 2013: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 16 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 172 |
| Number of retired or separated participants receiving benefits | 2013-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-08-01 | 0 |
| Total of all active and inactive participants | 2013-08-01 | 172 |
| Total participants | 2013-08-01 | 172 |
| 2012: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 161 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-08-01 | 0 |
| Total of all active and inactive participants | 2012-08-01 | 161 |
| Total participants | 2012-08-01 | 161 |
| 2011: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 155 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 155 |
| Total participants | 2011-01-01 | 155 |
| 2009: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 113 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-08-01 | 0 |
| Total of all active and inactive participants | 2009-08-01 | 113 |
| Total participants | 2009-08-01 | 113 |
| Measure | Date | Value |
|---|
| 2017 : J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-07-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-07-31 | $0 |
| Total income from all sources (including contributions) | 2017-07-31 | $1,551,515 |
| Total loss/gain on sale of assets | 2017-07-31 | $0 |
| Total of all expenses incurred | 2017-07-31 | $1,692,487 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-07-31 | $1,576,209 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-07-31 | $1,549,600 |
| Value of total assets at end of year | 2017-07-31 | $0 |
| Value of total assets at beginning of year | 2017-07-31 | $140,972 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-07-31 | $116,278 |
| Total interest from all sources | 2017-07-31 | $1,915 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-07-31 | No |
| Was this plan covered by a fidelity bond | 2017-07-31 | Yes |
| Value of fidelity bond cover | 2017-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-07-31 | No |
| Contributions received from participants | 2017-07-31 | $227,862 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-07-31 | $968 |
| Administrative expenses (other) incurred | 2017-07-31 | $0 |
| Total non interest bearing cash at end of year | 2017-07-31 | $0 |
| Total non interest bearing cash at beginning of year | 2017-07-31 | $140,972 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-07-31 | No |
| Value of net income/loss | 2017-07-31 | $-140,972 |
| Value of net assets at end of year (total assets less liabilities) | 2017-07-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-07-31 | $140,972 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-07-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-07-31 | $1,915 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-07-31 | $358,940 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-07-31 | No |
| Contributions received in cash from employer | 2017-07-31 | $1,320,770 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-07-31 | $1,217,269 |
| Contract administrator fees | 2017-07-31 | $116,278 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-07-31 | No |
| Did the plan have assets held for investment | 2017-07-31 | 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 | 2017-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-07-31 | Unqualified |
| Accountancy firm name | 2017-07-31 | RSM US LLP |
| Accountancy firm EIN | 2017-07-31 | 420714325 |
| 2016 : J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-07-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-07-31 | $0 |
| Total income from all sources (including contributions) | 2016-07-31 | $1,146,683 |
| Total loss/gain on sale of assets | 2016-07-31 | $0 |
| Total of all expenses incurred | 2016-07-31 | $2,448,641 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-07-31 | $2,378,901 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-07-31 | $1,145,515 |
| Value of total assets at end of year | 2016-07-31 | $140,972 |
| Value of total assets at beginning of year | 2016-07-31 | $1,442,930 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-07-31 | $69,740 |
| Total interest from all sources | 2016-07-31 | $1,168 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-07-31 | No |
| Administrative expenses professional fees incurred | 2016-07-31 | $44,142 |
| Was this plan covered by a fidelity bond | 2016-07-31 | Yes |
| Value of fidelity bond cover | 2016-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-07-31 | No |
| Contributions received from participants | 2016-07-31 | $258,657 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2016-07-31 | $20,766 |
| Total non interest bearing cash at end of year | 2016-07-31 | $140,972 |
| Total non interest bearing cash at beginning of year | 2016-07-31 | $1,442,930 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-07-31 | No |
| Value of net income/loss | 2016-07-31 | $-1,301,958 |
| Value of net assets at end of year (total assets less liabilities) | 2016-07-31 | $140,972 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-07-31 | $1,442,930 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-07-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-07-31 | $1,168 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-07-31 | $285,715 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-07-31 | No |
| Contributions received in cash from employer | 2016-07-31 | $866,092 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-07-31 | $2,093,186 |
| Contract administrator fees | 2016-07-31 | $25,598 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-07-31 | No |
| Did the plan have assets held for investment | 2016-07-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-07-31 | Unqualified |
| Accountancy firm name | 2016-07-31 | RSM US LLP |
| Accountancy firm EIN | 2016-07-31 | 420714325 |
| 2015 : J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-07-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-07-31 | $0 |
| Total income from all sources (including contributions) | 2015-07-31 | $2,007,418 |
| Total loss/gain on sale of assets | 2015-07-31 | $0 |
| Total of all expenses incurred | 2015-07-31 | $1,802,384 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-07-31 | $1,691,046 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-07-31 | $2,006,028 |
| Value of total assets at end of year | 2015-07-31 | $1,442,930 |
| Value of total assets at beginning of year | 2015-07-31 | $1,237,896 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-07-31 | $111,338 |
| Total interest from all sources | 2015-07-31 | $1,390 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-07-31 | No |
| Administrative expenses professional fees incurred | 2015-07-31 | $55,235 |
| Was this plan covered by a fidelity bond | 2015-07-31 | Yes |
| Value of fidelity bond cover | 2015-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-07-31 | No |
| Contributions received from participants | 2015-07-31 | $347,765 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2015-07-31 | $10,557 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-07-31 | No |
| Value of net income/loss | 2015-07-31 | $205,034 |
| Value of net assets at end of year (total assets less liabilities) | 2015-07-31 | $1,442,930 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-07-31 | $1,237,896 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-07-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-07-31 | $1,442,930 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-07-31 | $1,237,896 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-07-31 | $1,237,896 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-07-31 | $1,390 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-07-31 | $384,475 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-07-31 | No |
| Contributions received in cash from employer | 2015-07-31 | $1,647,706 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-07-31 | $1,306,571 |
| Contract administrator fees | 2015-07-31 | $56,103 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-07-31 | No |
| Did the plan have assets held for investment | 2015-07-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-07-31 | Unqualified |
| Accountancy firm name | 2015-07-31 | RSM US LLP |
| Accountancy firm EIN | 2015-07-31 | 420714325 |
| 2014 : J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-07-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-07-31 | $0 |
| Total income from all sources (including contributions) | 2014-07-31 | $1,827,396 |
| Total loss/gain on sale of assets | 2014-07-31 | $0 |
| Total of all expenses incurred | 2014-07-31 | $2,129,544 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-07-31 | $2,015,879 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-07-31 | $1,826,015 |
| Value of total assets at end of year | 2014-07-31 | $1,237,896 |
| Value of total assets at beginning of year | 2014-07-31 | $1,540,044 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-07-31 | $113,665 |
| Total interest from all sources | 2014-07-31 | $1,381 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-07-31 | No |
| Administrative expenses professional fees incurred | 2014-07-31 | $56,876 |
| Was this plan covered by a fidelity bond | 2014-07-31 | Yes |
| Value of fidelity bond cover | 2014-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-07-31 | No |
| Contributions received from participants | 2014-07-31 | $354,812 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2014-07-31 | $45,147 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-07-31 | No |
| Value of net income/loss | 2014-07-31 | $-302,148 |
| Value of net assets at end of year (total assets less liabilities) | 2014-07-31 | $1,237,896 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-07-31 | $1,540,044 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-07-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-07-31 | $1,237,896 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-07-31 | $1,540,044 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-07-31 | $1,540,044 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-07-31 | $1,381 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-07-31 | $402,024 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-07-31 | No |
| Contributions received in cash from employer | 2014-07-31 | $1,426,056 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-07-31 | $1,613,855 |
| Contract administrator fees | 2014-07-31 | $56,789 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-07-31 | No |
| Did the plan have assets held for investment | 2014-07-31 | 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 | 2014-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-07-31 | Unqualified |
| Accountancy firm name | 2014-07-31 | BATTELLE & BATTELLE |
| Accountancy firm EIN | 2014-07-31 | 310210560 |
| 2013 : J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-07-31 | $1,681,476 |
| Total of all expenses incurred | 2013-07-31 | $1,869,967 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-07-31 | $1,814,067 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-07-31 | $1,679,077 |
| Value of total assets at end of year | 2013-07-31 | $1,540,044 |
| Value of total assets at beginning of year | 2013-07-31 | $1,728,535 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-07-31 | $55,900 |
| Total interest from all sources | 2013-07-31 | $2,399 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-07-31 | No |
| Administrative expenses professional fees incurred | 2013-07-31 | $45,518 |
| Was this plan covered by a fidelity bond | 2013-07-31 | Yes |
| Value of fidelity bond cover | 2013-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-07-31 | No |
| Contributions received from participants | 2013-07-31 | $357,360 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-07-31 | No |
| Value of net income/loss | 2013-07-31 | $-188,491 |
| Value of net assets at end of year (total assets less liabilities) | 2013-07-31 | $1,540,044 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-07-31 | $1,728,535 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-07-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-07-31 | $1,540,044 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-07-31 | $1,728,535 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-07-31 | $1,728,535 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-07-31 | $2,399 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-07-31 | $434,276 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-07-31 | No |
| Contributions received in cash from employer | 2013-07-31 | $1,321,717 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-07-31 | $1,379,791 |
| Contract administrator fees | 2013-07-31 | $10,382 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-07-31 | No |
| Did the plan have assets held for investment | 2013-07-31 | 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 | 2013-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-07-31 | Unqualified |
| Accountancy firm name | 2013-07-31 | BATTELLE & BATTELLE |
| Accountancy firm EIN | 2013-07-31 | 310210560 |
| 2011 : J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-12-31 | $2,509,955 |
| Total of all expenses incurred | 2011-12-31 | $2,098,840 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $2,003,743 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $2,506,647 |
| Value of total assets at end of year | 2011-12-31 | $1,728,535 |
| Value of total assets at beginning of year | 2011-12-31 | $1,317,420 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $95,097 |
| Total interest from all sources | 2011-12-31 | $3,308 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $54,204 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $459,762 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $411,115 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $1,728,535 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $1,317,420 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $1,728,535 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $1,317,420 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $1,317,420 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $3,308 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $869,423 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $2,046,885 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $1,134,320 |
| Contract administrator fees | 2011-12-31 | $40,893 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Did the plan have assets held for investment | 2011-12-31 | 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 | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | BATTELLE & BATTELLE |
| Accountancy firm EIN | 2011-12-31 | 310210560 |
| Total income from all sources (including contributions) | 2011-07-31 | $2,024,321 |
| Total of all expenses incurred | 2011-07-31 | $1,611,725 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-07-31 | $1,532,322 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-07-31 | $1,812,150 |
| Value of total assets at end of year | 2011-07-31 | $1,317,420 |
| Value of total assets at beginning of year | 2011-07-31 | $904,824 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-07-31 | $79,403 |
| Total interest from all sources | 2011-07-31 | $212,171 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-07-31 | No |
| Administrative expenses professional fees incurred | 2011-07-31 | $44,021 |
| Was this plan covered by a fidelity bond | 2011-07-31 | Yes |
| Value of fidelity bond cover | 2011-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-07-31 | No |
| Contributions received from participants | 2011-07-31 | $337,712 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-07-31 | No |
| Value of net income/loss | 2011-07-31 | $412,596 |
| Value of net assets at end of year (total assets less liabilities) | 2011-07-31 | $1,317,420 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-07-31 | $904,824 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-07-31 | No |
| Interest earned on other investments | 2011-07-31 | $208,916 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-07-31 | $1,317,420 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-07-31 | $904,824 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-07-31 | $904,824 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-07-31 | $3,255 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-07-31 | $612,792 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-07-31 | No |
| Contributions received in cash from employer | 2011-07-31 | $1,474,438 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-07-31 | $919,530 |
| Contract administrator fees | 2011-07-31 | $35,382 |
| Did the plan have assets held for investment | 2011-07-31 | 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 | 2011-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-07-31 | No |
| 2022: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Submission has been amended | No |
| 2022-08-01 | This submission is the final filing | No |
| 2022-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-08-01 | Plan is a collectively bargained plan | No |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Submission has been amended | No |
| 2021-08-01 | This submission is the final filing | No |
| 2021-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-08-01 | Plan is a collectively bargained plan | No |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Submission has been amended | No |
| 2020-08-01 | This submission is the final filing | No |
| 2020-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-08-01 | Plan is a collectively bargained plan | No |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Submission has been amended | No |
| 2019-08-01 | This submission is the final filing | No |
| 2019-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-08-01 | Plan is a collectively bargained plan | No |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Submission has been amended | No |
| 2018-08-01 | This submission is the final filing | No |
| 2018-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-08-01 | Plan is a collectively bargained plan | No |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Submission has been amended | No |
| 2017-08-01 | This submission is the final filing | No |
| 2017-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-08-01 | Plan is a collectively bargained plan | No |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Submission has been amended | No |
| 2016-08-01 | This submission is the final filing | No |
| 2016-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-08-01 | Plan is a collectively bargained plan | No |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan funding arrangement – Trust | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement - Trust | Yes |
| 2015: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Submission has been amended | No |
| 2015-08-01 | This submission is the final filing | No |
| 2015-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-08-01 | Plan is a collectively bargained plan | No |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan funding arrangement – Trust | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement - Trust | Yes |
| 2014: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Submission has been amended | No |
| 2014-08-01 | This submission is the final filing | No |
| 2014-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-08-01 | Plan is a collectively bargained plan | No |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan funding arrangement – Trust | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement - Trust | Yes |
| 2013: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Submission has been amended | No |
| 2013-08-01 | This submission is the final filing | No |
| 2013-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-08-01 | Plan is a collectively bargained plan | No |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan funding arrangement – Trust | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement - Trust | Yes |
| 2012: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Submission has been amended | No |
| 2012-08-01 | This submission is the final filing | No |
| 2012-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-08-01 | Plan is a collectively bargained plan | No |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan funding arrangement – Trust | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement - Trust | Yes |
| 2011: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: J & M MANUFACTURING CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Submission has been amended | No |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-08-01 | Plan is a collectively bargained plan | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan funding arrangement – Trust | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement - Trust | Yes |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $1,661 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,414 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $886 | | Insurance broker organization code? | 3 |
|
| HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $623,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $1,432 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,112 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $668 | | Insurance broker organization code? | 5 |
|
| HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $467,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $1,282 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $683 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $424,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $472,846 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $700 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $700 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $413,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $1,203 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $695 | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $1,258 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $671 | | Insurance broker organization code? | 3 | | Insurance broker name | MEDICAL BENEFITS ADMINISTRATORS |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | 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 $406,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | 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 | 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 $306,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $1,230 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $6,966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $574 | | Insurance broker organization code? | 5 | | Insurance broker name | JACK KNAPSCHAEFER |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | 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 $340,663 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $1,712 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $9,696 | | Commission paid to Insurance Broker | USD $913 | | Insurance broker organization code? | 3 | | Insurance broker name | MEDICAL BENEFITS ADMINISTRATORS |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $208 | | 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 | 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 $390,545 | | Commission paid to Insurance Broker | USD $69 | | Insurance broker organization code? | 5 | | Insurance broker name | JACK KNAPSCHAEFER |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $1,691 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $9,580 | | Commission paid to Insurance Broker | USD $789 | | Insurance broker organization code? | 5 | | Insurance broker name | JACK KNAPSCHEFER |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $69,194 | | 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 | 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 $392,099 | | Commission paid to Insurance Broker | USD $23,065 | | Insurance broker organization code? | 5 | | Insurance broker name | JACK KNAPSCHAEFER |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $18 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $8,992 | | Commission paid to Insurance Broker | USD $741 | | Insurance broker organization code? | 5 | | Insurance broker name | JACK KNAPSCAEFER |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $122,323 | | Welfare Benefit Premiums Paid to Carrier | USD $815,489 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $2,169 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,456 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 1 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $90,341 | | Welfare Benefit Premiums Paid to Carrier | USD $602,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 10097 |
| Policy instance | 2 |
| Insurance contract or identification number | 10097 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2010-07-31 | | Total amount of commissions paid to insurance broker | USD $1,577 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,515 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
