401k Plan data: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN plan

TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 401k Plan overview

Plan Name	TRIPLE T. ENTERPRISES, INC. 401(K) PLAN
Plan identification number	101

TRIPLE T. ENTERPRISES, INC. 401(K) PLAN Benefits

401k Plan Type

Defined 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.

401k Sponsoring company profile

TRIPLE T. ENTERPRISES, INC. has sponsored the creation of one or more 401k plans.

Company Name: TRIPLE T. ENTERPRISES, INC.

Employer identification number (EIN): 820449559

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Additional information about TRIPLE T. ENTERPRISES, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1990-01-04

Company Identification Number: 601221248

Legal Registered Office Address: 5624 E 144TH ST

PUYALLUP
United States of America (USA)
98373

More information about TRIPLE T. ENTERPRISES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRIPLE T. ENTERPRISES, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
101 2021-01-01
101 2020-01-01
101 2019-01-01
101 2018-01-01 PHIL TISUE 2019-07-10
101 2017-01-01 PHIL TISUE 2018-08-14
101 2016-01-01 PHIL TISUE 2017-07-05
101 2015-01-01 PHIL TISUE 2016-09-27
101 2014-01-01 PHIL TISUE 2015-07-07
101 2013-01-01 PHIL TISUE 2014-06-27
101 2012-01-01 PHIL TISUE 2013-09-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
101	2021-01-01
101	2020-01-01
101	2019-01-01
101	2018-01-01	PHIL TISUE	2019-07-10
101	2017-01-01	PHIL TISUE	2018-08-14
101	2016-01-01	PHIL TISUE	2017-07-05
101	2015-01-01	PHIL TISUE	2016-09-27
101	2014-01-01	PHIL TISUE	2015-07-07
101	2013-01-01	PHIL TISUE	2014-06-27
101	2012-01-01	PHIL TISUE	2013-09-16

Plan Statistics for TRIPLE T. ENTERPRISES, INC. 401(K) PLAN

401k plan membership statisitcs for TRIPLE T. ENTERPRISES, INC. 401(K) PLAN

Measure Date Value
2021: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 196
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 5
Total of all active and inactive participants 2021-01-01 201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 201
Number of participants with account balances 2021-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 165
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 5
Total of all active and inactive participants 2020-01-01 170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 170
Number of participants with account balances 2020-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 115
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 6
Total of all active and inactive participants 2019-01-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 121
Number of participants with account balances 2019-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0

Measure	Date	Value
2021: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	196
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	5
Total of all active and inactive participants	2021-01-01	201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	201
Number of participants with account balances	2021-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	165
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	5
Total of all active and inactive participants	2020-01-01	170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	170
Number of participants with account balances	2020-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	115
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	6
Total of all active and inactive participants	2019-01-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	121
Number of participants with account balances	2019-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0

Financial Data on TRIPLE T. ENTERPRISES, INC. 401(K) PLAN

Measure	Date	Value
2021 : TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$84,228
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$3,371
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$14,617
Value of total assets at end of year	2021-12-31	$472,430
Value of total assets at beginning of year	2021-12-31	$391,573
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$3,371
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$14,617
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$435
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$80,857
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$472,430
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$391,573
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$467,115
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$386,292
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$5,315
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$4,846
Net investment gain/loss from pooled separate accounts	2021-12-31	$69,611
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contract administrator fees	2021-12-31	$3,371
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	THE NICHOLS ACCOUNTING GROUP PC
Accountancy firm EIN	2021-12-31	930989176
2020 : TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$73,596
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,897
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$409
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$13,196
Value of total assets at end of year	2020-12-31	$391,573
Value of total assets at beginning of year	2020-12-31	$319,874
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,488
Total interest from all sources	2020-12-31	$65
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$13,196
Participant contributions at end of year	2020-12-31	$435
Participant contributions at beginning of year	2020-12-31	$628
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$71,699
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$391,573
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$319,874
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$386,292
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$314,999
Interest earned on other investments	2020-12-31	$65
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$4,846
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$4,247
Net investment gain/loss from pooled separate accounts	2020-12-31	$60,335
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$409
Contract administrator fees	2020-12-31	$1,488
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	THE NICHOLS ACCOUNTING GROUP PC
Accountancy firm EIN	2020-12-31	930989176
2019 : TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$76,885
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$66,450
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$63,913
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$12,757
Value of total assets at end of year	2019-12-31	$319,874
Value of total assets at beginning of year	2019-12-31	$309,439
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,537
Total interest from all sources	2019-12-31	$61
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$12,757
Participant contributions at end of year	2019-12-31	$628
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$10,435
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$319,874
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$309,439
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$314,999
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$305,916
Interest earned on other investments	2019-12-31	$61
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$4,247
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$3,523
Net investment gain/loss from pooled separate accounts	2019-12-31	$64,067
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$63,913
Contract administrator fees	2019-12-31	$2,537
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	THE NICHOLS ACCOUNTING GROUP PC
Accountancy firm EIN	2019-12-31	930989176

Form 5500 Responses for TRIPLE T. ENTERPRISES, INC. 401(K) PLAN

2021: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: TRIPLE T. ENTERPRISES, INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-00497

Policy instance

Insurance contract or identification number	931061-00497
Number of Individuals Covered	201
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,725
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,416
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-00497

Policy instance

Insurance contract or identification number	931061-00497
Number of Individuals Covered	170
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,321
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,321
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-00497

Policy instance

Insurance contract or identification number	931061-00497
Number of Individuals Covered	121
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,162
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,162
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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Company Name:	TRIPLE T. ENTERPRISES, INC.
Employer identification number (EIN):	820449559
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1990-01-04
Company Identification Number:	601221248
Legal Registered Office Address:	5624 E 144TH ST PUYALLUP United States of America (USA) 98373