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TEAM BELVEDERE LLC 401(K) PLAN 401k Plan overview

Plan NameTEAM BELVEDERE LLC 401(K) PLAN
Plan identification number 001

TEAM BELVEDERE LLC 401(K) 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

TEAM BELVEDERE LLC has sponsored the creation of one or more 401k plans.

Company Name:TEAM BELVEDERE LLC
Employer identification number (EIN):020535442
NAIC Classification:523210
NAIC Description:Securities and Commodity Exchanges

Additional information about TEAM BELVEDERE LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 5423028

More information about TEAM BELVEDERE LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TEAM BELVEDERE LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012018-01-01
0012017-01-01WILLIAM D'ANNA WILLIAM D'ANNA2018-10-15
0012016-01-01WILLIAM DANNA WILLIAM DANNA2017-10-16
0012015-01-01WILLIAM A DANNA WILLIAM A DANNA2016-10-12
0012014-01-01WILLIAM D'ANNA WILLIAM D'ANNA2015-10-12
0012014-01-01WILLIAM A DANNA WILLIAM D'ANNA2015-10-13
0012013-01-01WILLIAM D'ANNA WILLIAM D'ANNA2014-09-19
0012012-01-01SHERYL PEVEN
0012011-01-01SHERYL PEVEN2012-06-25
0012010-01-01SHERYL PEVEN2011-06-29 SHERYL PEVEN2011-06-29

Plan Statistics for TEAM BELVEDERE LLC 401(K) PLAN

401k plan membership statisitcs for TEAM BELVEDERE LLC 401(K) PLAN

Measure Date Value
2018: TEAM BELVEDERE LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01290
Total number of active participants reported on line 7a of the Form 55002018-01-01241
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-0170
Total of all active and inactive participants2018-01-01312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01312
Number of participants with account balances2018-01-01267
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: TEAM BELVEDERE LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01270
Total number of active participants reported on line 7a of the Form 55002017-01-01229
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0158
Total of all active and inactive participants2017-01-01287
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01287
Number of participants with account balances2017-01-01241
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: TEAM BELVEDERE LLC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01239
Total number of active participants reported on line 7a of the Form 55002016-01-01214
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0155
Total of all active and inactive participants2016-01-01269
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01269
Number of participants with account balances2016-01-01214
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: TEAM BELVEDERE LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01227
Total number of active participants reported on line 7a of the Form 55002015-01-01193
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0143
Total of all active and inactive participants2015-01-01236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01236
Number of participants with account balances2015-01-01181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: TEAM BELVEDERE LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01208
Total number of active participants reported on line 7a of the Form 55002014-01-01187
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0134
Total of all active and inactive participants2014-01-01221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01221
Number of participants with account balances2014-01-01154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: TEAM BELVEDERE LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01186
Total number of active participants reported on line 7a of the Form 55002013-01-01178
Number of retired or separated participants receiving benefits2013-01-0130
Total of all active and inactive participants2013-01-01208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01208
Number of participants with account balances2013-01-01146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: TEAM BELVEDERE LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01153
Total number of active participants reported on line 7a of the Form 55002012-01-01173
Number of retired or separated participants receiving benefits2012-01-014
Number of other retired or separated participants entitled to future benefits2012-01-0110
Total of all active and inactive participants2012-01-01187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01187
Number of participants with account balances2012-01-01118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on TEAM BELVEDERE LLC 401(K) PLAN

Measure Date Value
2018 : TEAM BELVEDERE LLC 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$1,604,518
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,178,416
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,103,941
Expenses. Certain deemed distributions of participant loans2018-12-31$0
Value of total corrective distributions2018-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$2,847,740
Value of total assets at end of year2018-12-31$21,228,466
Value of total assets at beginning of year2018-12-31$20,802,364
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$74,475
Total interest from all sources2018-12-31$84,067
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$631,625
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$631,625
Administrative expenses professional fees incurred2018-12-31$0
Was this plan covered by a fidelity bond2018-12-31No
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$2,123,838
Participant contributions at end of year2018-12-31$92,643
Participant contributions at beginning of year2018-12-31$63,503
Assets. Other investments not covered elsewhere at end of year2018-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$0
Other income not declared elsewhere2018-12-31$0
Administrative expenses (other) incurred2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$426,102
Value of net assets at end of year (total assets less liabilities)2018-12-31$21,228,466
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$20,802,364
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$73,057
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$18,101,358
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$17,115,898
Value of interest in pooled separate accounts at end of year2018-12-31$0
Value of interest in pooled separate accounts at beginning of year2018-12-31$0
Interest on participant loans2018-12-31$3,609
Interest earned on other investments2018-12-31$80,458
Value of interest in common/collective trusts at end of year2018-12-31$0
Value of interest in common/collective trusts at beginning of year2018-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$3,034,465
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$3,622,963
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-1,958,914
Net investment gain/loss from pooled separate accounts2018-12-31$0
Net investment gain or loss from common/collective trusts2018-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Assets. Invements in employer securities at end of year2018-12-31$0
Assets. Invements in employer securities at beginning of year2018-12-31$0
Contributions received in cash from employer2018-12-31$723,902
Income. Dividends from common stock2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,103,941
Contract administrator fees2018-12-31$1,418
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31JESSER, RAVID, JASON, BASSO, AND FA
Accountancy firm EIN2018-12-31363207723
2017 : TEAM BELVEDERE LLC 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$5,728,695
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,043,506
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$974,272
Expenses. Certain deemed distributions of participant loans2017-12-31$0
Value of total corrective distributions2017-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$2,937,971
Value of total assets at end of year2017-12-31$20,802,364
Value of total assets at beginning of year2017-12-31$16,117,175
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$69,234
Total interest from all sources2017-12-31$86,329
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$387,314
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$387,314
Administrative expenses professional fees incurred2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$1,917,357
Participant contributions at end of year2017-12-31$63,503
Participant contributions at beginning of year2017-12-31$94,101
Assets. Other investments not covered elsewhere at end of year2017-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$59,953
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-12-31$0
Other income not declared elsewhere2017-12-31$0
Administrative expenses (other) incurred2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$4,685,189
Value of net assets at end of year (total assets less liabilities)2017-12-31$20,802,364
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$16,117,175
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$67,779
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$17,115,898
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$13,145,867
Value of interest in pooled separate accounts at end of year2017-12-31$0
Value of interest in pooled separate accounts at beginning of year2017-12-31$0
Interest on participant loans2017-12-31$3,099
Interest earned on other investments2017-12-31$83,230
Value of interest in common/collective trusts at end of year2017-12-31$0
Value of interest in common/collective trusts at beginning of year2017-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$3,622,963
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$2,877,207
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$2,317,081
Net investment gain/loss from pooled separate accounts2017-12-31$0
Net investment gain or loss from common/collective trusts2017-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Assets. Invements in employer securities at end of year2017-12-31$0
Assets. Invements in employer securities at beginning of year2017-12-31$0
Contributions received in cash from employer2017-12-31$960,661
Income. Dividends from common stock2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$974,272
Contract administrator fees2017-12-31$1,455
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31JESSER, RAVID, JASON, BASSO, AND FA
Accountancy firm EIN2017-12-31363207723
2016 : TEAM BELVEDERE LLC 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$4,057,961
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,050,887
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,029,008
Expenses. Certain deemed distributions of participant loans2016-12-31$0
Value of total corrective distributions2016-12-31$1,490
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$2,812,286
Value of total assets at end of year2016-12-31$16,117,175
Value of total assets at beginning of year2016-12-31$13,110,101
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$20,389
Total interest from all sources2016-12-31$57,758
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$258,715
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$258,715
Administrative expenses professional fees incurred2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,791,739
Participant contributions at end of year2016-12-31$94,101
Participant contributions at beginning of year2016-12-31$124,133
Assets. Other investments not covered elsewhere at end of year2016-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$75,107
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$0
Other income not declared elsewhere2016-12-31$0
Administrative expenses (other) incurred2016-12-31$75
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$3,007,074
Value of net assets at end of year (total assets less liabilities)2016-12-31$16,117,175
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$13,110,101
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$18,914
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$13,145,867
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$11,122,081
Value of interest in pooled separate accounts at end of year2016-12-31$0
Value of interest in pooled separate accounts at beginning of year2016-12-31$0
Interest on participant loans2016-12-31$4,631
Interest earned on other investments2016-12-31$53,127
Value of interest in common/collective trusts at end of year2016-12-31$0
Value of interest in common/collective trusts at beginning of year2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$2,877,207
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$1,863,887
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$929,202
Net investment gain/loss from pooled separate accounts2016-12-31$0
Net investment gain or loss from common/collective trusts2016-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Assets. Invements in employer securities at end of year2016-12-31$0
Assets. Invements in employer securities at beginning of year2016-12-31$0
Contributions received in cash from employer2016-12-31$945,440
Income. Dividends from common stock2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$1,029,008
Contract administrator fees2016-12-31$1,400
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31JESSER RAVID LLP
Accountancy firm EIN2016-12-31363207723
2015 : TEAM BELVEDERE LLC 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$2,972,928
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$1,374,044
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,372,394
Expenses. Certain deemed distributions of participant loans2015-12-31$0
Value of total corrective distributions2015-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$3,140,880
Value of total assets at end of year2015-12-31$13,110,101
Value of total assets at beginning of year2015-12-31$11,511,217
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$1,650
Total interest from all sources2015-12-31$35,026
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$604,922
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$604,922
Administrative expenses professional fees incurred2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31No
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$1,602,162
Participant contributions at end of year2015-12-31$124,133
Participant contributions at beginning of year2015-12-31$108,977
Assets. Other investments not covered elsewhere at end of year2015-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$41,865
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$0
Other income not declared elsewhere2015-12-31$0
Administrative expenses (other) incurred2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$1,598,884
Value of net assets at end of year (total assets less liabilities)2015-12-31$13,110,101
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$11,511,217
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$11,122,081
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$10,402,077
Value of interest in pooled separate accounts at end of year2015-12-31$0
Value of interest in pooled separate accounts at beginning of year2015-12-31$0
Interest on participant loans2015-12-31$4,321
Interest earned on other investments2015-12-31$30,705
Value of interest in common/collective trusts at end of year2015-12-31$0
Value of interest in common/collective trusts at beginning of year2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$1,863,887
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$1,000,163
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-807,900
Net investment gain/loss from pooled separate accounts2015-12-31$0
Net investment gain or loss from common/collective trusts2015-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Assets. Invements in employer securities at end of year2015-12-31$0
Assets. Invements in employer securities at beginning of year2015-12-31$0
Contributions received in cash from employer2015-12-31$1,496,853
Income. Dividends from common stock2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$1,372,394
Contract administrator fees2015-12-31$1,650
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31JESSER, RAVID, JASON, BASSO AND FAR
Accountancy firm EIN2015-12-31363207723
2014 : TEAM BELVEDERE LLC 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$2,673,564
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$567,940
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$567,900
Expenses. Certain deemed distributions of participant loans2014-12-31$0
Value of total corrective distributions2014-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,977,246
Value of total assets at end of year2014-12-31$12,183,517
Value of total assets at beginning of year2014-12-31$10,077,893
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$40
Total interest from all sources2014-12-31$5,078
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$742,149
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$742,149
Administrative expenses professional fees incurred2014-12-31$0
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,291,568
Participant contributions at end of year2014-12-31$108,977
Participant contributions at beginning of year2014-12-31$29,061
Participant contributions at beginning of year2014-12-31$35,000
Assets. Other investments not covered elsewhere at end of year2014-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$13,378
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-12-31$0
Other income not declared elsewhere2014-12-31$21
Administrative expenses (other) incurred2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$2,105,624
Value of net assets at end of year (total assets less liabilities)2014-12-31$12,183,517
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$10,077,893
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$10,402,077
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$8,194,754
Value of interest in pooled separate accounts at end of year2014-12-31$0
Value of interest in pooled separate accounts at beginning of year2014-12-31$0
Interest on participant loans2014-12-31$4,130
Interest earned on other investments2014-12-31$948
Value of interest in common/collective trusts at end of year2014-12-31$0
Value of interest in common/collective trusts at beginning of year2014-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$1,000,163
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$1,187,687
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$-50,930
Net investment gain/loss from pooled separate accounts2014-12-31$0
Net investment gain or loss from common/collective trusts2014-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Assets. Invements in employer securities at end of year2014-12-31$0
Assets. Invements in employer securities at beginning of year2014-12-31$0
Contributions received in cash from employer2014-12-31$672,300
Employer contributions (assets) at end of year2014-12-31$672,300
Employer contributions (assets) at beginning of year2014-12-31$631,391
Income. Dividends from common stock2014-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$567,900
Contract administrator fees2014-12-31$40
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31Yes
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31JESSER, RAVID, JASON, BASSO AND FAR
Accountancy firm EIN2014-12-31363207723
2013 : TEAM BELVEDERE LLC 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$3,663,967
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$114,338
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$94,772
Expenses. Certain deemed distributions of participant loans2013-12-31$19,067
Value of total corrective distributions2013-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$2,351,017
Value of total assets at end of year2013-12-31$10,077,893
Value of total assets at beginning of year2013-12-31$6,528,264
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$499
Total interest from all sources2013-12-31$982
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$1,233,577
Participant contributions at end of year2013-12-31$29,061
Participant contributions at beginning of year2013-12-31$21,599
Participant contributions at end of year2013-12-31$35,000
Participant contributions at beginning of year2013-12-31$68,376
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$486,049
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$262
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$3,549,629
Value of net assets at end of year (total assets less liabilities)2013-12-31$10,077,893
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$6,528,264
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$8,194,754
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$5,003,202
Interest on participant loans2013-12-31$982
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$1,187,687
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$854,398
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$1,311,968
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$631,391
Employer contributions (assets) at end of year2013-12-31$631,391
Employer contributions (assets) at beginning of year2013-12-31$580,427
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$94,772
Contract administrator fees2013-12-31$499
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31RAVID & BERNSTEIN LLP
Accountancy firm EIN2013-12-31363207723
2012 : TEAM BELVEDERE LLC 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$2,653,615
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$335,394
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$334,773
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$2,158,969
Value of total assets at end of year2012-12-31$6,528,264
Value of total assets at beginning of year2012-12-31$4,210,043
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$621
Total interest from all sources2012-12-31$746
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$472,896
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$1,116,258
Participant contributions at end of year2012-12-31$21,599
Participant contributions at beginning of year2012-12-31$43,685
Participant contributions at end of year2012-12-31$68,376
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$14,488
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$262
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$2,318,221
Value of net assets at end of year (total assets less liabilities)2012-12-31$6,528,264
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$4,210,043
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$5,003,202
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$3,534,915
Interest on participant loans2012-12-31$746
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$854,398
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$631,443
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$493,900
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$1,028,223
Employer contributions (assets) at end of year2012-12-31$580,427
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$334,773
Contract administrator fees2012-12-31$621
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31RAVID & BERNSTEIN LLP
Accountancy firm EIN2012-12-31363207723

Form 5500 Responses for TEAM BELVEDERE LLC 401(K) PLAN

2018: TEAM BELVEDERE LLC 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: TEAM BELVEDERE LLC 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: TEAM BELVEDERE LLC 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: TEAM BELVEDERE LLC 401(K) 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: TEAM BELVEDERE LLC 401(K) 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: TEAM BELVEDERE LLC 401(K) 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: TEAM BELVEDERE LLC 401(K) 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

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 61496
Policy instance 1
Insurance contract or identification numberMR 61496
Number of Individuals Covered312
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 61496
Policy instance 1
Insurance contract or identification numberMR 61496
Number of Individuals Covered287
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-BO-ZL05
Policy instance 2
Insurance contract or identification numberGAP-BO-ZL05
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 61496
Policy instance 1
Insurance contract or identification numberMR 61496
Number of Individuals Covered236
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,315
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 $7,315
Insurance broker organization code?4
Insurance broker nameSBHU LIFE AGENCY INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B3-ZL06
Policy instance 3
Insurance contract or identification numberGAP-B3-ZL06
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $16
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
Commission paid to Insurance BrokerUSD $16
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSECURITIES AMERICA, INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B0-ZL05
Policy instance 2
Insurance contract or identification numberGAP-B0-ZL05
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,782
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
Commission paid to Insurance BrokerUSD $5,782
Insurance broker organization code?3
Insurance broker nameSECURITIES AMERICA, INC
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 61496
Policy instance 1
Insurance contract or identification numberMR 61496
Number of Individuals Covered221
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $818
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 $818
Insurance broker organization code?4
Insurance broker nameSBHU LIFE AGENCY INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-BO-ZL06
Policy instance 2
Insurance contract or identification numberGAP-BO-ZL06
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $128
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
Commission paid to Insurance BrokerUSD $128
Insurance broker organization code?3
Insurance broker nameSECURITIES AMERICA, INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B0-ZL05
Policy instance 1
Insurance contract or identification numberGAP-B0-ZL05
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,537
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
Commission paid to Insurance BrokerUSD $6,537
Insurance broker organization code?3
Insurance broker nameSECURITIES AMERICA, INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B0-ZL05
Policy instance 1
Insurance contract or identification numberGAP-B0-ZL05
Number of Individuals Covered118
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,641
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
Commission paid to Insurance BrokerUSD $4,641
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSECURITIES AMERICA, INC

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