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DBLS HOLDINGS LTD. 401(K) PLAN 401k Plan overview

Plan NameDBLS HOLDINGS LTD. 401(K) PLAN
Plan identification number 001

DBLS HOLDINGS LTD. 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.
  • 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

DBLS HOLDINGS LTD. has sponsored the creation of one or more 401k plans.

Company Name:DBLS HOLDINGS LTD.
Employer identification number (EIN):043180247
NAIC Classification:561900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DBLS HOLDINGS LTD. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01HUGH A O'REILLY2023-06-28
0012021-01-01HUGH A O'REILLY2022-05-17
0012020-01-01HUGH A O'REILLY2021-06-30
0012019-01-01HUGH A O'REILLY2020-07-28
0012018-01-01HUGH A. O'REILLY2019-07-22 HUGH A. O'REILLY2019-07-22
0012017-01-01WENDY EICHOLZER
0012016-01-01LEONARD DAVENPORT
0012015-01-01LEONARD DAVENPORT
0012014-01-01LEONARD DAVENPORT
0012013-01-01LEONARD DAVENPORT
0012012-01-01LEONARD DAVENPORT
0012011-01-01DARRELL GRIFFIN
0012009-01-01DARRELL GRIFFIN
0012008-01-01DARRELL GRIFFIN
0012007-01-01DARRELL GRIFFIN

Plan Statistics for DBLS HOLDINGS LTD. 401(K) PLAN

401k plan membership statisitcs for DBLS HOLDINGS LTD. 401(K) PLAN

Measure Date Value
2017: DBLS HOLDINGS LTD. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0116
Total number of active participants reported on line 7a of the Form 55002017-01-0110
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0116
Number of participants with account balances2017-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: DBLS HOLDINGS LTD. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0116
Total number of active participants reported on line 7a of the Form 55002016-01-0110
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-016
Total of all active and inactive participants2016-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0116
Number of participants with account balances2016-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: DBLS HOLDINGS LTD. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0115
Total number of active participants reported on line 7a of the Form 55002015-01-0110
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-016
Total of all active and inactive participants2015-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0116
Number of participants with account balances2015-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: DBLS HOLDINGS LTD. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0115
Total number of active participants reported on line 7a of the Form 55002014-01-017
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-017
Total of all active and inactive participants2014-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0114
Number of participants with account balances2014-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: DBLS HOLDINGS LTD. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0117
Total number of active participants reported on line 7a of the Form 55002013-01-017
Number of retired or separated participants receiving benefits2013-01-011
Number of other retired or separated participants entitled to future benefits2013-01-017
Total of all active and inactive participants2013-01-0115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0115
Number of participants with account balances2013-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: DBLS HOLDINGS LTD. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0124
Total number of active participants reported on line 7a of the Form 55002012-01-017
Number of retired or separated participants receiving benefits2012-01-011
Number of other retired or separated participants entitled to future benefits2012-01-018
Total of all active and inactive participants2012-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0116
Number of participants with account balances2012-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: DBLS HOLDINGS LTD. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0130
Total number of active participants reported on line 7a of the Form 55002011-01-018
Number of retired or separated participants receiving benefits2011-01-013
Number of other retired or separated participants entitled to future benefits2011-01-0121
Total of all active and inactive participants2011-01-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0132
Number of participants with account balances2011-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: DBLS HOLDINGS LTD. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0129
Total number of active participants reported on line 7a of the Form 55002009-01-0117
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0112
Total of all active and inactive participants2009-01-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0129
Number of participants with account balances2009-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010
2008: DBLS HOLDINGS LTD. 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-0129
Total number of active participants reported on line 7a of the Form 55002008-01-0119
Number of retired or separated participants receiving benefits2008-01-010
Number of other retired or separated participants entitled to future benefits2008-01-019
Total of all active and inactive participants2008-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-01-010
Total participants2008-01-0128
Number of participants with account balances2008-01-0127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-01-010
2007: DBLS HOLDINGS LTD. 401(K) PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-0131
Total number of active participants reported on line 7a of the Form 55002007-01-0120
Number of retired or separated participants receiving benefits2007-01-010
Number of other retired or separated participants entitled to future benefits2007-01-018
Total of all active and inactive participants2007-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-01-010
Total participants2007-01-0128
Number of participants with account balances2007-01-0126

Financial Data on DBLS HOLDINGS LTD. 401(K) PLAN

Measure Date Value
2017 : DBLS HOLDINGS LTD. 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$193,614
Expenses. Total of all expenses incurred2017-12-31$4,281
Total plan assets at end of year2017-12-31$1,254,874
Total plan assets at beginning of year2017-12-31$1,065,541
Value of fidelity bond covering the plan2017-12-31$100,000
Total contributions received or receivable from participants2017-12-31$42,441
Other income received2017-12-31$151,173
Net income (gross income less expenses)2017-12-31$189,333
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,254,874
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,065,541
Assets. Value of participant loans2017-12-31$22,283
Value of corrective distributions2017-12-31$3,520
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$761
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : DBLS HOLDINGS LTD. 401(K) PLAN 2016 401k financial data
Total income from all sources2016-12-31$119,451
Expenses. Total of all expenses incurred2016-12-31$5,503
Benefits paid (including direct rollovers)2016-12-31$1,145
Total plan assets at end of year2016-12-31$1,065,541
Total plan assets at beginning of year2016-12-31$951,593
Value of fidelity bond covering the plan2016-12-31$100,000
Total contributions received or receivable from participants2016-12-31$42,157
Other income received2016-12-31$77,294
Net income (gross income less expenses)2016-12-31$113,948
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,065,541
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$951,593
Assets. Value of participant loans2016-12-31$28,563
Value of corrective distributions2016-12-31$3,838
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$520
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : DBLS HOLDINGS LTD. 401(K) PLAN 2015 401k financial data
Total income from all sources2015-12-31$31,965
Expenses. Total of all expenses incurred2015-12-31$64,436
Benefits paid (including direct rollovers)2015-12-31$57,877
Total plan assets at end of year2015-12-31$951,593
Total plan assets at beginning of year2015-12-31$984,064
Value of fidelity bond covering the plan2015-12-31$100,000
Total contributions received or receivable from participants2015-12-31$41,818
Other income received2015-12-31$-9,853
Net income (gross income less expenses)2015-12-31$-32,471
Net plan assets at end of year (total assets less liabilities)2015-12-31$951,593
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$984,064
Assets. Value of participant loans2015-12-31$34,505
Value of corrective distributions2015-12-31$5,901
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$658
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : DBLS HOLDINGS LTD. 401(K) PLAN 2014 401k financial data
Total income from all sources2014-12-31$99,168
Expenses. Total of all expenses incurred2014-12-31$65,939
Benefits paid (including direct rollovers)2014-12-31$65,939
Total plan assets at end of year2014-12-31$984,064
Total plan assets at beginning of year2014-12-31$950,835
Value of fidelity bond covering the plan2014-12-31$100,000
Total contributions received or receivable from participants2014-12-31$36,541
Other income received2014-12-31$62,627
Net income (gross income less expenses)2014-12-31$33,229
Net plan assets at end of year (total assets less liabilities)2014-12-31$984,064
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$950,835
Assets. Value of participant loans2014-12-31$40,128
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : DBLS HOLDINGS LTD. 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$176,036
Expenses. Total of all expenses incurred2013-12-31$27,201
Benefits paid (including direct rollovers)2013-12-31$14,956
Total plan assets at end of year2013-12-31$950,835
Total plan assets at beginning of year2013-12-31$802,000
Value of fidelity bond covering the plan2013-12-31$100,000
Total contributions received or receivable from participants2013-12-31$46,702
Other income received2013-12-31$129,334
Net income (gross income less expenses)2013-12-31$148,835
Net plan assets at end of year (total assets less liabilities)2013-12-31$950,835
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$802,000
Assets. Value of participant loans2013-12-31$45,448
Value of corrective distributions2013-12-31$12,245
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : DBLS HOLDINGS LTD. 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$126,001
Expenses. Total of all expenses incurred2012-12-31$307,456
Benefits paid (including direct rollovers)2012-12-31$307,456
Total plan assets at end of year2012-12-31$802,000
Total plan assets at beginning of year2012-12-31$983,455
Value of fidelity bond covering the plan2012-12-31$100,000
Total contributions received or receivable from participants2012-12-31$45,678
Other income received2012-12-31$80,323
Net income (gross income less expenses)2012-12-31$-181,455
Net plan assets at end of year (total assets less liabilities)2012-12-31$802,000
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$983,455
Assets. Value of participant loans2012-12-31$27,326
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : DBLS HOLDINGS LTD. 401(K) PLAN 2011 401k financial data
Total income from all sources2011-12-31$50,013
Expenses. Total of all expenses incurred2011-12-31$198,506
Benefits paid (including direct rollovers)2011-12-31$198,506
Total plan assets at end of year2011-12-31$983,455
Total plan assets at beginning of year2011-12-31$1,131,948
Value of fidelity bond covering the plan2011-12-31$100,000
Total contributions received or receivable from participants2011-12-31$54,886
Other income received2011-12-31$-4,873
Net income (gross income less expenses)2011-12-31$-148,493
Net plan assets at end of year (total assets less liabilities)2011-12-31$983,455
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,131,948
Assets. Value of participant loans2011-12-31$28,290
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022011-12-31$35,780
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : DBLS HOLDINGS LTD. 401(K) PLAN 2010 401k financial data
Total income from all sources2010-12-31$174,849
Expenses. Total of all expenses incurred2010-12-31$43,631
Benefits paid (including direct rollovers)2010-12-31$43,631
Total plan assets at end of year2010-12-31$1,131,948
Total plan assets at beginning of year2010-12-31$1,000,730
Value of fidelity bond covering the plan2010-12-31$100,000
Total contributions received or receivable from participants2010-12-31$66,726
Other income received2010-12-31$108,123
Net income (gross income less expenses)2010-12-31$131,218
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,131,948
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,000,730
Assets. Value of participant loans2010-12-31$29,157
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022010-12-31$61,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : DBLS HOLDINGS LTD. 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0
2008 : DBLS HOLDINGS LTD. 401(K) PLAN 2008 401k financial data
Total income from all sources2008-12-31$-201,091
Expenses. Total of all expenses incurred2008-12-31$29,967
Benefits paid (including direct rollovers)2008-12-31$29,967
Total plan assets at end of year2008-12-31$749,020
Total plan assets at beginning of year2008-12-31$980,078
Value of fidelity bond covering the plan2008-12-31$98,000
Total contributions received or receivable from participants2008-12-31$95,913
Other income received2008-12-31$-341,297
Net income (gross income less expenses)2008-12-31$-231,058
Net plan assets at end of year (total assets less liabilities)2008-12-31$749,020
Net plan assets at beginning of year (total assets less liabilities)2008-12-31$980,078
Assets. Value of participant loans2008-12-31$24,683
Total contributions received or receivable from employer(s)2008-12-31$44,293
2007 : DBLS HOLDINGS LTD. 401(K) PLAN 2007 401k financial data
Total income from all sources2007-12-31$181,315
Expenses. Total of all expenses incurred2007-12-31$57,905
Benefits paid (including direct rollovers)2007-12-31$57,905
Total plan assets at end of year2007-12-31$980,078
Total plan assets at beginning of year2007-12-31$856,668
Value of fidelity bond covering the plan2007-12-31$98,000
Total contributions received or receivable from participants2007-12-31$95,694
Other income received2007-12-31$48,404
Net income (gross income less expenses)2007-12-31$123,410
Net plan assets at end of year (total assets less liabilities)2007-12-31$980,078
Net plan assets at beginning of year (total assets less liabilities)2007-12-31$856,668
Total contributions received or receivable from employer(s)2007-12-31$37,217

Form 5500 Responses for DBLS HOLDINGS LTD. 401(K) PLAN

2017: DBLS HOLDINGS LTD. 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: DBLS HOLDINGS LTD. 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: DBLS HOLDINGS LTD. 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: DBLS HOLDINGS LTD. 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: DBLS HOLDINGS LTD. 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: DBLS HOLDINGS LTD. 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
2011: DBLS HOLDINGS LTD. 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: DBLS HOLDINGS LTD. 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes
2008: DBLS HOLDINGS LTD. 401(K) PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – TrustYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement - TrustYes
2007: DBLS HOLDINGS LTD. 401(K) PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedYes
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – TrustYes
2007-01-01Plan benefit arrangement – InsuranceYes
2007-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number931193-01
Policy instance 1
Insurance contract or identification number931193-01
Number of Individuals Covered12
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,791
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
Commission paid to Insurance BrokerUSD $2,544
Insurance broker organization code?3
Insurance broker nameJAMES HORROCKS

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