401k Plan data: SUPPLEMENTAL DISABILITY plan

SUPPLEMENTAL DISABILITY 401k Plan overview

Plan Name	SUPPLEMENTAL DISABILITY
Plan identification number	506

SUPPLEMENTAL DISABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Long-term disability cover

401k Sponsoring company profile

HOME BUILDERS INSTITUTE has sponsored the creation of one or more 401k plans.

Company Name: HOME BUILDERS INSTITUTE

Employer identification number (EIN): 521266885

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUPPLEMENTAL DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2015-01-01 FAYE NOCK EDWARD HARRISON 2016-11-21
506 2014-01-01 FAYE NOCK EDWARD HARRISON 2015-06-22
506 2013-01-01 FAYE NOCK EDWARD HARRISON 2014-04-28
506 2012-01-01 FAYE NOCK EDWARD HARRISON 2013-04-25
506 2011-09-01 FAYE NOCK EDWARD HARRISON 2012-07-10
506 2011-01-01 FAYE NOCK EDWARD HARRISON 2012-07-12
506 2010-01-01 FAYE NOCK EDWARD HARRISON 2011-05-31

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
506	2015-01-01	FAYE NOCK	EDWARD HARRISON	2016-11-21
506	2014-01-01	FAYE NOCK	EDWARD HARRISON	2015-06-22
506	2013-01-01	FAYE NOCK	EDWARD HARRISON	2014-04-28
506	2012-01-01	FAYE NOCK	EDWARD HARRISON	2013-04-25
506	2011-09-01	FAYE NOCK	EDWARD HARRISON	2012-07-10
506	2011-01-01	FAYE NOCK	EDWARD HARRISON	2012-07-12
506	2010-01-01	FAYE NOCK	EDWARD HARRISON	2011-05-31

Plan Statistics for SUPPLEMENTAL DISABILITY

401k plan membership statisitcs for SUPPLEMENTAL DISABILITY

Measure Date Value
2015: SUPPLEMENTAL DISABILITY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 11
Total of all active and inactive participants 2015-01-01 11
Total participants 2015-01-01 11
2014: SUPPLEMENTAL DISABILITY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 12
Total of all active and inactive participants 2014-01-01 12
Total participants 2014-01-01 12
2013: SUPPLEMENTAL DISABILITY 2013 401k membership
Total participants, beginning-of-year 2013-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 11
Total of all active and inactive participants 2013-01-01 11
Total participants 2013-01-01 11
2012: SUPPLEMENTAL DISABILITY 2012 401k membership
Total participants, beginning-of-year 2012-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 12
Total of all active and inactive participants 2012-01-01 12
Total participants 2012-01-01 12
2011: SUPPLEMENTAL DISABILITY 2011 401k membership
Total participants, beginning-of-year 2011-09-01 0
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 42
Total of all active and inactive participants 2011-09-01 42
Total participants 2011-09-01 42
Total participants, beginning-of-year 2011-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 12
Total of all active and inactive participants 2011-01-01 12
Total participants 2011-01-01 12
2010: SUPPLEMENTAL DISABILITY 2010 401k membership
Total participants, beginning-of-year 2010-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 11
Total of all active and inactive participants 2010-01-01 11
Total participants 2010-01-01 11

Measure	Date	Value
2015: SUPPLEMENTAL DISABILITY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	11
Total of all active and inactive participants	2015-01-01	11
Total participants	2015-01-01	11
2014: SUPPLEMENTAL DISABILITY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	12
Total of all active and inactive participants	2014-01-01	12
Total participants	2014-01-01	12
2013: SUPPLEMENTAL DISABILITY 2013 401k membership
Total participants, beginning-of-year	2013-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	11
Total of all active and inactive participants	2013-01-01	11
Total participants	2013-01-01	11
2012: SUPPLEMENTAL DISABILITY 2012 401k membership
Total participants, beginning-of-year	2012-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	12
Total of all active and inactive participants	2012-01-01	12
Total participants	2012-01-01	12
2011: SUPPLEMENTAL DISABILITY 2011 401k membership
Total participants, beginning-of-year	2011-09-01	0
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	42
Total of all active and inactive participants	2011-09-01	42
Total participants	2011-09-01	42
Total participants, beginning-of-year	2011-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	12
Total of all active and inactive participants	2011-01-01	12
Total participants	2011-01-01	12
2010: SUPPLEMENTAL DISABILITY 2010 401k membership
Total participants, beginning-of-year	2010-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	11
Total of all active and inactive participants	2010-01-01	11
Total participants	2010-01-01	11

Form 5500 Responses for SUPPLEMENTAL DISABILITY

2015: SUPPLEMENTAL DISABILITY 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SUPPLEMENTAL DISABILITY 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SUPPLEMENTAL DISABILITY 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SUPPLEMENTAL DISABILITY 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SUPPLEMENTAL DISABILITY 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
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 benefit arrangement – Insurance	Yes
2010: SUPPLEMENTAL DISABILITY 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

158552

Policy instance

Insurance contract or identification number	158552
Number of Individuals Covered	11
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $463
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
Other welfare benefits provided	DISABILITY INSURANCE
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 $5,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $463
Insurance broker name	J TODD MILLER & ASSOCIATES

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

158552

Policy instance

Insurance contract or identification number	158552
Number of Individuals Covered	12
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $982
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
Other welfare benefits provided	DISABILITY INSURANCE
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 $6,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $982
Insurance broker name	J TODD MILLER & ASSOCIATED INC

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

154016

Policy instance

Insurance contract or identification number	154016
Number of Individuals Covered	11
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $612
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
Other welfare benefits provided	DISABILITY INSURANCE
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 $4,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $612
Amount paid for insurance broker fees	0
Insurance broker name	J TODD MILLER & ASSOCIATES

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

154016

Policy instance

Insurance contract or identification number	154016
Number of Individuals Covered	12
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $1,092
Other welfare benefits provided	DISABILITY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,092
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	J TODD MILLER & ASSOCIATES, INC.

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R036330

Policy instance

Insurance contract or identification number	R036330
Number of Individuals Covered	42
Insurance policy start date	2011-09-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $11,064
Total amount of fees paid to insurance company	USD $11
Other welfare benefits provided	GROUP CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000154016

Policy instance

Insurance contract or identification number	0000154016
Number of Individuals Covered	12
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $1,302
Total amount of fees paid to insurance company	USD $105
Other welfare benefits provided	DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $7,658

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

154016

Policy instance

Insurance contract or identification number	154016
Number of Individuals Covered	11
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $3,338
Total amount of fees paid to insurance company	USD $706
Other welfare benefits provided	DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $6,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,338
Amount paid for insurance broker fees	706
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	J TODD MILLER & ASSOCIATES

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Company Name:	HOME BUILDERS INSTITUTE
Employer identification number (EIN):	521266885
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations