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OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan NameOMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN
Plan identification number 001

OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 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.
  • Plan covering Self-Employed individuals.
  • 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.

401k Sponsoring company profile

OMNI LIFE SCIENCE, INC. has sponsored the creation of one or more 401k plans.

Company Name:OMNI LIFE SCIENCE, INC.
Employer identification number (EIN):770493092
NAIC Classification:423400

Additional information about OMNI LIFE SCIENCE, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2018-05-17
Company Identification Number: 144078698
Legal Registered Office Address: 10701 SW NELSON ST

TUALATIN
United States of America (USA)
97062

More information about OMNI LIFE SCIENCE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-01-01NANCY KEENAN2020-10-15
0012018-01-01KATHRYN GERRISH2019-09-30 KATHRYN GERRISH2019-09-30
0012017-01-01KENNETH SMITH2018-06-11 JAMES BARRILE2018-06-11
0012016-01-01KENNETH SMITH2017-07-19 JAMES BARRILE2017-07-19
0012016-01-01KENNETH SMITH2017-07-19 JAMES BARRILE2017-07-19
0012015-01-01KENNETH SMITH JAMES BARRILE2016-07-13
0012014-01-01MARLO MAE MANNING MARLO MAE MANNING2015-07-15
0012013-01-01MARLO MANNING
0012012-01-01CHRIS CONTI CHRIS CONTI2013-05-20
0012011-01-01CHRIS CONTI CHRIS CONTI2012-05-21
0012010-01-01CHRIS CONTI
0012009-01-01CHRIS CONTI CHRIS CONTI2010-06-24

Plan Statistics for OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2015: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0188
Total number of active participants reported on line 7a of the Form 55002015-01-0174
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0120
Total of all active and inactive participants2015-01-0194
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0194
Number of participants with account balances2015-01-0168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0156
Total number of active participants reported on line 7a of the Form 55002014-01-0180
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-018
Total of all active and inactive participants2014-01-0188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0188
Number of participants with account balances2014-01-0164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0180
Total number of active participants reported on line 7a of the Form 55002013-01-0141
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0115
Total of all active and inactive participants2013-01-0156
Total participants2013-01-0156
Number of participants with account balances2013-01-0156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0172
Total number of active participants reported on line 7a of the Form 55002012-01-0160
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0120
Total of all active and inactive participants2012-01-0180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0180
Number of participants with account balances2012-01-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0163
Total number of active participants reported on line 7a of the Form 55002011-01-0154
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0118
Total of all active and inactive participants2011-01-0172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0172
Number of participants with account balances2011-01-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0139
Total number of active participants reported on line 7a of the Form 55002010-01-0152
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0111
Total of all active and inactive participants2010-01-0163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0163
Number of participants with account balances2010-01-0133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0136
Total number of active participants reported on line 7a of the Form 55002009-01-0127
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0112
Total of all active and inactive participants2009-01-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0139
Number of participants with account balances2009-01-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2015 : OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 401k financial data
Total income from all sources2015-12-31$1,106,051
Expenses. Total of all expenses incurred2015-12-31$158,155
Benefits paid (including direct rollovers)2015-12-31$156,903
Total plan assets at end of year2015-12-31$4,605,740
Total plan assets at beginning of year2015-12-31$3,657,844
Value of fidelity bond covering the plan2015-12-31$1,000,000
Total contributions received or receivable from participants2015-12-31$658,303
Contributions received from other sources (not participants or employers)2015-12-31$166,803
Other income received2015-12-31$25,077
Net income (gross income less expenses)2015-12-31$947,896
Net plan assets at end of year (total assets less liabilities)2015-12-31$4,605,740
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$3,657,844
Assets. Value of participant loans2015-12-31$110,460
Total contributions received or receivable from employer(s)2015-12-31$255,868
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$1,252
2014 : OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2014 401k financial data
Total income from all sources2014-12-31$991,530
Expenses. Total of all expenses incurred2014-12-31$401,998
Benefits paid (including direct rollovers)2014-12-31$400,884
Total plan assets at end of year2014-12-31$3,657,844
Total plan assets at beginning of year2014-12-31$3,068,312
Value of fidelity bond covering the plan2014-12-31$1,000,000
Total contributions received or receivable from participants2014-12-31$512,120
Contributions received from other sources (not participants or employers)2014-12-31$54,579
Other income received2014-12-31$202,069
Net income (gross income less expenses)2014-12-31$589,532
Net plan assets at end of year (total assets less liabilities)2014-12-31$3,657,844
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$3,068,312
Assets. Value of participant loans2014-12-31$65,644
Total contributions received or receivable from employer(s)2014-12-31$222,762
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$1,114
2013 : OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2013 401k financial data
Total income from all sources2013-12-31$1,106,872
Expenses. Total of all expenses incurred2013-12-31$264,306
Benefits paid (including direct rollovers)2013-12-31$263,901
Total plan assets at end of year2013-12-31$3,068,312
Total plan assets at beginning of year2013-12-31$2,225,746
Value of fidelity bond covering the plan2013-12-31$1,000,000
Total contributions received or receivable from participants2013-12-31$351,495
Contributions received from other sources (not participants or employers)2013-12-31$116,324
Other income received2013-12-31$485,438
Net income (gross income less expenses)2013-12-31$842,566
Net plan assets at end of year (total assets less liabilities)2013-12-31$3,068,312
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$2,225,746
Assets. Value of participant loans2013-12-31$23,125
Total contributions received or receivable from employer(s)2013-12-31$153,615
Value of certain deemed distributions of participant loans2013-12-31$55
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$350
2012 : OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2012 401k financial data
Total income from all sources2012-12-31$781,555
Expenses. Total of all expenses incurred2012-12-31$62,728
Benefits paid (including direct rollovers)2012-12-31$61,853
Total plan assets at end of year2012-12-31$2,225,746
Total plan assets at beginning of year2012-12-31$1,506,919
Value of fidelity bond covering the plan2012-12-31$1,000,000
Total contributions received or receivable from participants2012-12-31$315,708
Contributions received from other sources (not participants or employers)2012-12-31$76,340
Other income received2012-12-31$225,924
Net income (gross income less expenses)2012-12-31$718,827
Net plan assets at end of year (total assets less liabilities)2012-12-31$2,225,746
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,506,919
Assets. Value of participant loans2012-12-31$27,306
Total contributions received or receivable from employer(s)2012-12-31$163,583
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$875
2011 : OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2011 401k financial data
Total income from all sources2011-12-31$370,259
Expenses. Total of all expenses incurred2011-12-31$42,029
Benefits paid (including direct rollovers)2011-12-31$40,909
Total plan assets at end of year2011-12-31$1,506,919
Total plan assets at beginning of year2011-12-31$1,178,689
Value of fidelity bond covering the plan2011-12-31$250,000
Total contributions received or receivable from participants2011-12-31$284,914
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-59,727
Net income (gross income less expenses)2011-12-31$328,230
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,506,919
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,178,689
Assets. Value of participant loans2011-12-31$19,158
Total contributions received or receivable from employer(s)2011-12-31$145,072
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$1,120
2010 : OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2010 401k financial data
Total income from all sources2010-12-31$501,713
Expenses. Total of all expenses incurred2010-12-31$3,541
Benefits paid (including direct rollovers)2010-12-31$2,686
Total plan assets at end of year2010-12-31$1,178,689
Total plan assets at beginning of year2010-12-31$680,517
Value of fidelity bond covering the plan2010-12-31$250,000
Total contributions received or receivable from participants2010-12-31$217,131
Contributions received from other sources (not participants or employers)2010-12-31$43,760
Other income received2010-12-31$132,636
Net income (gross income less expenses)2010-12-31$498,172
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,178,689
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$680,517
Assets. Value of participant loans2010-12-31$24,825
Total contributions received or receivable from employer(s)2010-12-31$108,186
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$855

Form 5500 Responses for OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN

2015: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
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
2015-01-01Plan benefit arrangement - TrustYes
2014: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 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 funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 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
2013-01-01Plan benefit arrangement - TrustYes
2012: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 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
2012-01-01Plan benefit arrangement - TrustYes
2011: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: OMNI LIFE SCIENCE, INC. 401(K) RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberZH9595
Policy instance 1
Insurance contract or identification numberZH9595
Number of Individuals Covered94
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,246
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,246
Insurance broker organization code?3
Insurance broker nameSBHU LIFE AGENCY INC
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberZH9595
Policy instance 1
Insurance contract or identification numberZH9595
Number of Individuals Covered88
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,503
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,503
Insurance broker organization code?3
Insurance broker nameSBHU LIFE AGENCY INC
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberZH9595
Policy instance 1
Insurance contract or identification numberZH9595
Number of Individuals Covered56
Insurance policy start date2013-04-09
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,723
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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 $5,723
Insurance broker organization code?3
Insurance broker nameSBHU LIFE AGENCY INC
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number936352
Policy instance 1
Insurance contract or identification number936352
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-04-08
Total amount of commissions paid to insurance brokerUSD $2,190
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
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 $2,190
Insurance broker organization code?4
Insurance broker nameMORGAN STANLEY SMITH BARNEY LLC
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberZH9595
Policy instance 2
Insurance contract or identification numberZH9595
Number of Individuals Covered80
Insurance policy start date2012-04-09
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $21,526
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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 $18,677
Insurance broker organization code?3
Insurance broker nameSBHU LIFE AGENCY INC
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number936352
Policy instance 1
Insurance contract or identification number936352
Number of Individuals Covered51
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,410
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number936352
Policy instance 1
Insurance contract or identification number936352
Number of Individuals Covered33
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,226
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,226
Insurance broker organization code?4
Insurance broker nameMORGAN STANLEY SMITH BARNEY LLC

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