401k Plan data: VOLUNTARY SUPPLEMENTAL AD&D plan

VOLUNTARY SUPPLEMENTAL AD&D 401k Plan overview

Plan Name	VOLUNTARY SUPPLEMENTAL AD&D
Plan identification number	508

VOLUNTARY SUPPLEMENTAL AD&D Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

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 VOLUNTARY SUPPLEMENTAL AD&D

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2015-01-01 FAYE NOCK EDWARD HARRISON 2016-11-02
508 2014-01-01 FAYE NOCK EDWARD HARRISON 2015-06-22
508 2013-01-01 FAYE NOCK EDWARD HARRISON 2014-04-28
508 2012-01-01 FAYE NOCK EDWARD HARRISON 2013-04-25
508 2011-09-01 FAYE NOCK EDWARD HARRISON 2012-08-08

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
508	2015-01-01	FAYE NOCK	EDWARD HARRISON	2016-11-02
508	2014-01-01	FAYE NOCK	EDWARD HARRISON	2015-06-22
508	2013-01-01	FAYE NOCK	EDWARD HARRISON	2014-04-28
508	2012-01-01	FAYE NOCK	EDWARD HARRISON	2013-04-25
508	2011-09-01	FAYE NOCK	EDWARD HARRISON	2012-08-08

Plan Statistics for VOLUNTARY SUPPLEMENTAL AD&D

401k plan membership statisitcs for VOLUNTARY SUPPLEMENTAL AD&D

Measure Date Value
2015: VOLUNTARY SUPPLEMENTAL AD&D 2015 401k membership
Total participants, beginning-of-year 2015-01-01 61
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 60
Total of all active and inactive participants 2015-01-01 60
Total participants 2015-01-01 60
2014: VOLUNTARY SUPPLEMENTAL AD&D 2014 401k membership
Total participants, beginning-of-year 2014-01-01 70
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 61
Total of all active and inactive participants 2014-01-01 61
Total participants 2014-01-01 61
2013: VOLUNTARY SUPPLEMENTAL AD&D 2013 401k membership
Total participants, beginning-of-year 2013-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 70
Total of all active and inactive participants 2013-01-01 70
Total participants 2013-01-01 70
2012: VOLUNTARY SUPPLEMENTAL AD&D 2012 401k membership
Total participants, beginning-of-year 2012-01-01 66
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 37
Total of all active and inactive participants 2012-01-01 37
Total participants 2012-01-01 37
2011: VOLUNTARY SUPPLEMENTAL AD&D 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 66
Total of all active and inactive participants 2011-09-01 66
Total participants 2011-09-01 66

Measure	Date	Value
2015: VOLUNTARY SUPPLEMENTAL AD&D 2015 401k membership
Total participants, beginning-of-year	2015-01-01	61
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	60
Total of all active and inactive participants	2015-01-01	60
Total participants	2015-01-01	60
2014: VOLUNTARY SUPPLEMENTAL AD&D 2014 401k membership
Total participants, beginning-of-year	2014-01-01	70
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	61
Total of all active and inactive participants	2014-01-01	61
Total participants	2014-01-01	61
2013: VOLUNTARY SUPPLEMENTAL AD&D 2013 401k membership
Total participants, beginning-of-year	2013-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	70
Total of all active and inactive participants	2013-01-01	70
Total participants	2013-01-01	70
2012: VOLUNTARY SUPPLEMENTAL AD&D 2012 401k membership
Total participants, beginning-of-year	2012-01-01	66
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	37
Total of all active and inactive participants	2012-01-01	37
Total participants	2012-01-01	37
2011: VOLUNTARY SUPPLEMENTAL AD&D 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	66
Total of all active and inactive participants	2011-09-01	66
Total participants	2011-09-01	66

Form 5500 Responses for VOLUNTARY SUPPLEMENTAL AD&D

2015: VOLUNTARY SUPPLEMENTAL AD&D 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 benefit arrangement – Insurance	Yes
2014: VOLUNTARY SUPPLEMENTAL AD&D 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 benefit arrangement – Insurance	Yes
2013: VOLUNTARY SUPPLEMENTAL AD&D 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 benefit arrangement – Insurance	Yes
2012: VOLUNTARY SUPPLEMENTAL AD&D 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: VOLUNTARY SUPPLEMENTAL AD&D 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 – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

298840

Policy instance

Insurance contract or identification number	298840
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $6,072
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
Other welfare benefits provided	LIFESTYLE ADD
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 $40,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,072
Insurance broker organization code?	3
Insurance broker name	J TODD MILLER AND ASSOCIATES INC

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

Policy contract number

298840

Policy instance

Insurance contract or identification number	298840
Number of Individuals Covered	61
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $522
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	VOLUNTARY SUPPLEMENTAL AD&D
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 $3,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $522
Insurance broker organization code?	3
Insurance broker name	J TODD MILLER & ASSOCIATED INC

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

Policy contract number

298840

Policy instance

Insurance contract or identification number	298840
Number of Individuals Covered	70
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $282
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	AD&D
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 $1,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $282
Amount paid for insurance broker fees	36
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	J TODD MILLER & ASSOCIATES

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

Policy contract number

298840

Policy instance

Insurance contract or identification number	298840
Number of Individuals Covered	37
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $55
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55
Amount paid for insurance broker fees	7
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	J TODD MILLER & ASSOCIATES

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

Policy contract number

R0207373

Policy instance

Insurance contract or identification number	R0207373
Number of Individuals Covered	66
Insurance policy start date	2011-09-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $104
Total amount of fees paid to insurance company	USD $10
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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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