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EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 401k Plan overview

Plan NameEMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC.
Plan identification number 001

EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

TENNANT TRUCK LINES, INC. has sponsored the creation of one or more 401k plans.

Company Name:TENNANT TRUCK LINES, INC.
Employer identification number (EIN):366069190
NAIC Classification:484120
NAIC Description: General Freight Trucking, Long-Distance

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-01-01
0012016-01-01JUSTIN NASON
0012015-01-01LARRY RUSBARSKY LARRY RUSBARSKY2016-10-17
0012015-01-01 LARRY RUSBARSKY2016-10-17
0012014-01-01LAURENCE RUSBARSKY LAURENCE RUSBARSKY2016-08-01
0012013-01-01TODD STONER TODD STONER2014-07-10
0012012-01-01TODD STONER TODD STONER2013-07-23
0012011-01-01TODD STONER2012-07-19
0012010-01-01ERIN TENNANT2011-07-24

Plan Statistics for EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC.

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC.

Measure Date Value
2016: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2016 401k membership
Total participants, beginning-of-year2016-01-01175
Total number of active participants reported on line 7a of the Form 55002016-01-0123
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0177
Total of all active and inactive participants2016-01-01100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-011
Total participants2016-01-01101
Number of participants with account balances2016-01-0192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0185
2015: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2015 401k membership
Total participants, beginning-of-year2015-01-01198
Total number of active participants reported on line 7a of the Form 55002015-01-01118
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0156
Total of all active and inactive participants2015-01-01174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-011
Total participants2015-01-01175
Number of participants with account balances2015-01-01174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0170
2014: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2014 401k membership
Total participants, beginning-of-year2014-01-01157
Total number of active participants reported on line 7a of the Form 55002014-01-01155
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0143
Total of all active and inactive participants2014-01-01198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01198
Number of participants with account balances2014-01-01198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0152
2013: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2013 401k membership
Total participants, beginning-of-year2013-01-0197
Total number of active participants reported on line 7a of the Form 55002013-01-01184
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0114
Total of all active and inactive participants2013-01-01198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01198
Number of participants with account balances2013-01-01157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-017
2012: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2012 401k membership
Total participants, beginning-of-year2012-01-01108
Total number of active participants reported on line 7a of the Form 55002012-01-0196
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0112
Total of all active and inactive participants2012-01-01108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01108
Number of participants with account balances2012-01-01102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0122

Financial Data on EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC.

Measure Date Value
2016 : EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$197,159
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$2,530,216
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,528,226
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$118,573
Value of total assets at end of year2016-12-31$874,781
Value of total assets at beginning of year2016-12-31$3,207,838
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,990
Total interest from all sources2016-12-31$617
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$374,345
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$68,245
Administrative expenses (other) incurred2016-12-31$1,990
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-2,333,057
Value of net assets at end of year (total assets less liabilities)2016-12-31$874,781
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$3,207,838
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$846,159
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$3,078,992
Interest earned on other investments2016-12-31$617
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$28,622
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$128,846
Net investment gain/loss from pooled separate accounts2016-12-31$77,969
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$50,328
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,528,226
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2016-12-31410746749
2015 : EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$388,091
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$200,249
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$197,269
Expenses. Certain deemed distributions of participant loans2015-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$418,163
Value of total assets at end of year2015-12-31$3,207,838
Value of total assets at beginning of year2015-12-31$3,019,996
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$2,980
Total interest from all sources2015-12-31$690
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$300,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$232,958
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$0
Other income not declared elsewhere2015-12-31$2,121
Administrative expenses (other) incurred2015-12-31$2,980
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$187,842
Value of net assets at end of year (total assets less liabilities)2015-12-31$3,207,838
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$3,019,996
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$3,078,992
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$3,006,958
Interest on participant loans2015-12-31$0
Interest earned on other investments2015-12-31$690
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$128,846
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$13,038
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$0
Net investment gain/loss from pooled separate accounts2015-12-31$-32,883
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$185,205
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$197,269
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
2014 : EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$615,525
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$319,781
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$316,706
Expenses. Certain deemed distributions of participant loans2014-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$440,635
Value of total assets at end of year2014-12-31$3,019,996
Value of total assets at beginning of year2014-12-31$2,724,252
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$3,075
Total interest from all sources2014-12-31$73
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$246,536
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$0
Administrative expenses (other) incurred2014-12-31$3,075
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$295,744
Value of net assets at end of year (total assets less liabilities)2014-12-31$3,019,996
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$2,724,252
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$3,006,958
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$2,721,090
Interest on participant loans2014-12-31$0
Interest earned on other investments2014-12-31$73
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$13,038
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$3,162
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$0
Net investment gain/loss from pooled separate accounts2014-12-31$174,817
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
Contributions received in cash from employer2014-12-31$194,099
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$316,706
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 PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
2013 : EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$890,896
Expenses. Total of all expenses incurred2013-12-31$128,700
Benefits paid (including direct rollovers)2013-12-31$92,495
Total plan assets at end of year2013-12-31$2,724,252
Total plan assets at beginning of year2013-12-31$1,962,056
Value of fidelity bond covering the plan2013-12-31$300,000
Total contributions received or receivable from participants2013-12-31$174,693
Expenses. Other expenses not covered elsewhere2013-12-31$36,205
Contributions received from other sources (not participants or employers)2013-12-31$44,150
Other income received2013-12-31$544,317
Net income (gross income less expenses)2013-12-31$762,196
Net plan assets at end of year (total assets less liabilities)2013-12-31$2,724,252
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,962,056
Total contributions received or receivable from employer(s)2013-12-31$127,736
Value of certain deemed distributions of participant loans2013-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$581,521
Expenses. Total of all expenses incurred2012-12-31$206,599
Benefits paid (including direct rollovers)2012-12-31$159,101
Total plan assets at end of year2012-12-31$2,076,156
Total plan assets at beginning of year2012-12-31$1,701,234
Value of fidelity bond covering the plan2012-12-31$300,000
Total contributions received or receivable from participants2012-12-31$103,973
Expenses. Other expenses not covered elsewhere2012-12-31$47,498
Contributions received from other sources (not participants or employers)2012-12-31$198,214
Other income received2012-12-31$127,577
Net income (gross income less expenses)2012-12-31$374,922
Net plan assets at end of year (total assets less liabilities)2012-12-31$2,076,156
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,701,234
Total contributions received or receivable from employer(s)2012-12-31$151,757
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC.

2016: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: EMPLOYEE BENEFIT PLAN OF TENNANT TRUCK LINES, INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058820I
Policy instance 1
Insurance contract or identification number058820I
Number of Individuals Covered175
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,536
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1536
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameCHICAGO REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number05820I
Policy instance 1
Insurance contract or identification number05820I
Number of Individuals Covered198
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $689
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058820I
Policy instance 1
Insurance contract or identification number058820I
Number of Individuals Covered157
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,328
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2328
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameCHICAGO REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058820I
Policy instance 1
Insurance contract or identification number058820I
Number of Individuals Covered108
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

Potentially related plans

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