BC ADHESIVES, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BC ADHESIVES 401(K) SAVINGS PLAN
| Measure | Date | Value |
|---|
| 2022: BC ADHESIVES 401(K) SAVINGS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 15 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 15 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 1 |
| Total of all active and inactive participants | 2022-01-01 | 16 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2022-01-01 | 0 |
| Total participants | 2022-01-01 | 16 |
| Number of participants with account balances | 2022-01-01 | 15 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2022-01-01 | 0 |
| 2021: BC ADHESIVES 401(K) SAVINGS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 15 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 15 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 15 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2021-01-01 | 0 |
| Total participants | 2021-01-01 | 15 |
| Number of participants with account balances | 2021-01-01 | 15 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2021-01-01 | 0 |
| 2020: BC ADHESIVES 401(K) SAVINGS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 15 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 15 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 15 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2020-01-01 | 0 |
| Total participants | 2020-01-01 | 15 |
| Number of participants with account balances | 2020-01-01 | 15 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2020-01-01 | 0 |
| 2019: BC ADHESIVES 401(K) SAVINGS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 17 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 14 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 1 |
| Total of all active and inactive participants | 2019-01-01 | 15 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 15 |
| Number of participants with account balances | 2019-01-01 | 15 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 1 |
| 2018: BC ADHESIVES 401(K) SAVINGS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 17 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 17 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 17 |
| Number of participants with account balances | 2018-01-01 | 13 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| 2017: BC ADHESIVES 401(K) SAVINGS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 11 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 11 |
| Number of participants with account balances | 2017-01-01 | 11 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 0 |
| 2016: BC ADHESIVES 401(K) SAVINGS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 11 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 0 |
| Total participants | 2016-01-01 | 11 |
| Number of participants with account balances | 2016-01-01 | 11 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-01-01 | 0 |
| 2015: BC ADHESIVES 401(K) SAVINGS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 11 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-01-01 | 0 |
| Total participants | 2015-01-01 | 11 |
| Number of participants with account balances | 2015-01-01 | 10 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-01-01 | 0 |
| 2014: BC ADHESIVES 401(K) SAVINGS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 10 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 1 |
| Total of all active and inactive participants | 2014-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 11 |
| Number of participants with account balances | 2014-01-01 | 11 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 0 |
| 2013: BC ADHESIVES 401(K) SAVINGS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 8 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 10 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 1 |
| Total of all active and inactive participants | 2013-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 11 |
| Number of participants with account balances | 2013-01-01 | 10 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: BC ADHESIVES 401(K) SAVINGS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 8 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 8 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 8 |
| Number of participants with account balances | 2012-01-01 | 8 |
| 2011: BC ADHESIVES 401(K) SAVINGS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 7 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 7 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 7 |
| Number of participants with account balances | 2011-01-01 | 7 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2010: BC ADHESIVES 401(K) SAVINGS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 6 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 6 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 6 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 6 |
| Number of participants with account balances | 2010-01-01 | 6 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: BC ADHESIVES 401(K) SAVINGS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 6 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 6 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 6 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 6 |
| Number of participants with account balances | 2009-01-01 | 6 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2022 : BC ADHESIVES 401(K) SAVINGS PLAN 2022 401k financial data |
|---|
| Transfers to/from the plan | 2022-12-31 | $0 |
| Total plan liabilities at end of year | 2022-12-31 | $0 |
| Total plan liabilities at beginning of year | 2022-12-31 | $0 |
| Total income from all sources | 2022-12-31 | $-448,277 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $35,173 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $0 |
| Total plan assets at end of year | 2022-12-31 | $5,536,406 |
| Total plan assets at beginning of year | 2022-12-31 | $6,019,856 |
| Value of fidelity bond covering the plan | 2022-12-31 | $300,000 |
| Assets. Value of tangible personal property | 2022-12-31 | $0 |
| Total contributions received or receivable from participants | 2022-12-31 | $195,195 |
| Assets. Value of loans (other than to participants) | 2022-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $0 |
| Other income received | 2022-12-31 | $-928,258 |
| Noncash contributions received | 2022-12-31 | $0 |
| Net income (gross income less expenses) | 2022-12-31 | $-483,450 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $5,536,406 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $6,019,856 |
| Assets. Value of participant loans | 2022-12-31 | $10,316 |
| Assets. Value of assets in partnership/joint-venture interests | 2022-12-31 | $0 |
| Assets. Value of real-estate (other than employer real property) | 2022-12-31 | $0 |
| Assets. Value of employer securities | 2022-12-31 | $0 |
| Assets. Value of employer real property | 2022-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $284,786 |
| Value of certain deemed distributions of participant loans | 2022-12-31 | $0 |
| Value of corrective distributions | 2022-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $35,173 |
| 2021 : BC ADHESIVES 401(K) SAVINGS PLAN 2021 401k financial data |
|---|
| Transfers to/from the plan | 2021-12-31 | $0 |
| Total plan liabilities at end of year | 2021-12-31 | $0 |
| Total plan liabilities at beginning of year | 2021-12-31 | $0 |
| Total income from all sources | 2021-12-31 | $888,945 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $578,634 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $539,490 |
| Total plan assets at end of year | 2021-12-31 | $6,019,856 |
| Total plan assets at beginning of year | 2021-12-31 | $5,709,545 |
| Value of fidelity bond covering the plan | 2021-12-31 | $300,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $183,669 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2021-12-31 | $0 |
| Other income received | 2021-12-31 | $667,200 |
| Noncash contributions received | 2021-12-31 | $0 |
| Net income (gross income less expenses) | 2021-12-31 | $310,311 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $6,019,856 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $5,709,545 |
| Assets. Value of participant loans | 2021-12-31 | $10,123 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $38,076 |
| Value of certain deemed distributions of participant loans | 2021-12-31 | $0 |
| Value of corrective distributions | 2021-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $39,144 |
| 2020 : BC ADHESIVES 401(K) SAVINGS PLAN 2020 401k financial data |
|---|
| Transfers to/from the plan | 2020-12-31 | $0 |
| Total plan liabilities at end of year | 2020-12-31 | $0 |
| Total plan liabilities at beginning of year | 2020-12-31 | $0 |
| Total income from all sources | 2020-12-31 | $1,123,256 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $45,916 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $11,249 |
| Total plan assets at end of year | 2020-12-31 | $5,709,545 |
| Total plan assets at beginning of year | 2020-12-31 | $4,632,205 |
| Value of fidelity bond covering the plan | 2020-12-31 | $300,000 |
| Assets. Value of tangible personal property | 2020-12-31 | $0 |
| Total contributions received or receivable from participants | 2020-12-31 | $173,886 |
| Assets. Value of loans (other than to participants) | 2020-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2020-12-31 | $79,185 |
| Other income received | 2020-12-31 | $583,172 |
| Noncash contributions received | 2020-12-31 | $0 |
| Net income (gross income less expenses) | 2020-12-31 | $1,077,340 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $5,709,545 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $4,632,205 |
| Assets. Value of participant loans | 2020-12-31 | $13,383 |
| Assets. Value of assets in partnership/joint-venture interests | 2020-12-31 | $0 |
| Assets. Value of real-estate (other than employer real property) | 2020-12-31 | $0 |
| Assets. Value of employer securities | 2020-12-31 | $0 |
| Assets. Value of employer real property | 2020-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $287,013 |
| Value of certain deemed distributions of participant loans | 2020-12-31 | $0 |
| Value of corrective distributions | 2020-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $34,667 |
| 2019 : BC ADHESIVES 401(K) SAVINGS PLAN 2019 401k financial data |
|---|
| Transfers to/from the plan | 2019-12-31 | $0 |
| Total plan liabilities at end of year | 2019-12-31 | $0 |
| Total plan liabilities at beginning of year | 2019-12-31 | $0 |
| Total income from all sources | 2019-12-31 | $1,122,479 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $597,122 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $567,153 |
| Total plan assets at end of year | 2019-12-31 | $4,632,205 |
| Total plan assets at beginning of year | 2019-12-31 | $4,106,848 |
| Value of fidelity bond covering the plan | 2019-12-31 | $300,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $166,575 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2019-12-31 | $4,127 |
| Other income received | 2019-12-31 | $692,851 |
| Noncash contributions received | 2019-12-31 | $0 |
| Net income (gross income less expenses) | 2019-12-31 | $525,357 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $4,632,205 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $4,106,848 |
| Assets. Value of participant loans | 2019-12-31 | $16,661 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $258,926 |
| Value of certain deemed distributions of participant loans | 2019-12-31 | $0 |
| Value of corrective distributions | 2019-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $29,969 |
| 2018 : BC ADHESIVES 401(K) SAVINGS PLAN 2018 401k financial data |
|---|
| Transfers to/from the plan | 2018-12-31 | $0 |
| Total plan liabilities at end of year | 2018-12-31 | $0 |
| Total plan liabilities at beginning of year | 2018-12-31 | $0 |
| Total income from all sources | 2018-12-31 | $222,813 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $47,175 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $18,795 |
| Total plan assets at end of year | 2018-12-31 | $4,106,848 |
| Total plan assets at beginning of year | 2018-12-31 | $3,931,210 |
| Value of fidelity bond covering the plan | 2018-12-31 | $300,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $118,806 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2018-12-31 | $0 |
| Other income received | 2018-12-31 | $-172,493 |
| Noncash contributions received | 2018-12-31 | $0 |
| Net income (gross income less expenses) | 2018-12-31 | $175,638 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $4,106,848 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $3,931,210 |
| Assets. Value of participant loans | 2018-12-31 | $20,236 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $276,500 |
| Value of certain deemed distributions of participant loans | 2018-12-31 | $0 |
| Value of corrective distributions | 2018-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $28,380 |
| 2017 : BC ADHESIVES 401(K) SAVINGS PLAN 2017 401k financial data |
|---|
| Transfers to/from the plan | 2017-12-31 | $0 |
| Total plan liabilities at end of year | 2017-12-31 | $0 |
| Total plan liabilities at beginning of year | 2017-12-31 | $0 |
| Total income from all sources | 2017-12-31 | $1,224,661 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $16,989 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $0 |
| Total plan assets at end of year | 2017-12-31 | $3,931,210 |
| Total plan assets at beginning of year | 2017-12-31 | $2,723,538 |
| Value of fidelity bond covering the plan | 2017-12-31 | $300,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $109,559 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2017-12-31 | $495,251 |
| Other income received | 2017-12-31 | $391,353 |
| Noncash contributions received | 2017-12-31 | $0 |
| Net income (gross income less expenses) | 2017-12-31 | $1,207,672 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $3,931,210 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $2,723,538 |
| Assets. Value of participant loans | 2017-12-31 | $24,131 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $228,498 |
| Value of certain deemed distributions of participant loans | 2017-12-31 | $0 |
| Value of corrective distributions | 2017-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $16,989 |
| 2016 : BC ADHESIVES 401(K) SAVINGS PLAN 2016 401k financial data |
|---|
| Transfers to/from the plan | 2016-12-31 | $0 |
| Total plan liabilities at end of year | 2016-12-31 | $0 |
| Total plan liabilities at beginning of year | 2016-12-31 | $0 |
| Total income from all sources | 2016-12-31 | $403,201 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $14,043 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $0 |
| Total plan assets at end of year | 2016-12-31 | $2,723,538 |
| Total plan assets at beginning of year | 2016-12-31 | $2,334,380 |
| Value of fidelity bond covering the plan | 2016-12-31 | $300,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $131,885 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2016-12-31 | $0 |
| Other income received | 2016-12-31 | $125,703 |
| Noncash contributions received | 2016-12-31 | $0 |
| Net income (gross income less expenses) | 2016-12-31 | $389,158 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $2,723,538 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $2,334,380 |
| Assets. Value of participant loans | 2016-12-31 | $18,000 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $145,613 |
| Value of certain deemed distributions of participant loans | 2016-12-31 | $0 |
| Value of corrective distributions | 2016-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $14,043 |
| 2015 : BC ADHESIVES 401(K) SAVINGS PLAN 2015 401k financial data |
|---|
| Transfers to/from the plan | 2015-12-31 | $0 |
| Total plan liabilities at end of year | 2015-12-31 | $0 |
| Total plan liabilities at beginning of year | 2015-12-31 | $0 |
| Total income from all sources | 2015-12-31 | $-35,867 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $8,846 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $1,278 |
| Total plan assets at end of year | 2015-12-31 | $2,334,380 |
| Total plan assets at beginning of year | 2015-12-31 | $2,379,093 |
| Value of fidelity bond covering the plan | 2015-12-31 | $300,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $21,641 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2015-12-31 | $59,429 |
| Other income received | 2015-12-31 | $-319,685 |
| Noncash contributions received | 2015-12-31 | $0 |
| Net income (gross income less expenses) | 2015-12-31 | $-44,713 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $2,334,380 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $2,379,093 |
| Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102 | 2015-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $202,748 |
| Value of certain deemed distributions of participant loans | 2015-12-31 | $0 |
| Value of corrective distributions | 2015-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $7,568 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2015-12-31 | $0 |
| 2014 : BC ADHESIVES 401(K) SAVINGS PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $583,329 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $151,131 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $140,572 |
| Total plan assets at end of year | 2014-12-31 | $2,394,712 |
| Total plan assets at beginning of year | 2014-12-31 | $1,962,514 |
| Value of fidelity bond covering the plan | 2014-12-31 | $200,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $70,555 |
| Contributions received from other sources (not participants or employers) | 2014-12-31 | $290,106 |
| Other income received | 2014-12-31 | $19,920 |
| Net income (gross income less expenses) | 2014-12-31 | $432,198 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $2,394,712 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $1,962,514 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $202,748 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $10,559 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2014-12-31 | $0 |
| 2013 : BC ADHESIVES 401(K) SAVINGS PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $308,567 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $20,530 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $12,134 |
| Total plan assets at end of year | 2013-12-31 | $1,962,514 |
| Total plan assets at beginning of year | 2013-12-31 | $1,674,477 |
| Value of fidelity bond covering the plan | 2013-12-31 | $90,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $68,849 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2013-12-31 | $0 |
| Other income received | 2013-12-31 | $39,898 |
| Noncash contributions received | 2013-12-31 | $0 |
| Net income (gross income less expenses) | 2013-12-31 | $288,037 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $1,962,514 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $1,674,477 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $199,820 |
| Value of certain deemed distributions of participant loans | 2013-12-31 | $0 |
| Value of corrective distributions | 2013-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $8,396 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2013-12-31 | $0 |
| 2012 : BC ADHESIVES 401(K) SAVINGS PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $367,842 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $6,152 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $0 |
| Total plan assets at end of year | 2012-12-31 | $1,674,477 |
| Total plan assets at beginning of year | 2012-12-31 | $1,312,787 |
| Value of fidelity bond covering the plan | 2012-12-31 | $90,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $68,124 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $0 |
| Other income received | 2012-12-31 | $101,674 |
| Noncash contributions received | 2012-12-31 | $0 |
| Net income (gross income less expenses) | 2012-12-31 | $361,690 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $1,674,477 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $1,312,787 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $198,044 |
| Value of certain deemed distributions of participant loans | 2012-12-31 | $0 |
| Value of corrective distributions | 2012-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $6,152 |
| 2011 : BC ADHESIVES 401(K) SAVINGS PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $178,151 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $63,329 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $0 |
| Total plan assets at end of year | 2011-12-31 | $1,312,787 |
| Total plan assets at beginning of year | 2011-12-31 | $1,197,965 |
| Value of fidelity bond covering the plan | 2011-12-31 | $90,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $61,130 |
| Contributions received from other sources (not participants or employers) | 2011-12-31 | $0 |
| Other income received | 2011-12-31 | $-64,798 |
| Noncash contributions received | 2011-12-31 | $0 |
| Net income (gross income less expenses) | 2011-12-31 | $114,822 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $1,312,787 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $1,197,965 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $181,819 |
| Value of certain deemed distributions of participant loans | 2011-12-31 | $63,270 |
| Value of corrective distributions | 2011-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $59 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2011-12-31 | $0 |
| 2010 : BC ADHESIVES 401(K) SAVINGS PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $293,651 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $2,677 |
| Total plan assets at end of year | 2010-12-31 | $1,197,965 |
| Total plan assets at beginning of year | 2010-12-31 | $906,991 |
| Value of fidelity bond covering the plan | 2010-12-31 | $90,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $61,425 |
| Other income received | 2010-12-31 | $81,795 |
| Net income (gross income less expenses) | 2010-12-31 | $290,974 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $1,197,965 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $906,991 |
| Assets. Value of participant loans | 2010-12-31 | $61,472 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $150,431 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $2,677 |
| 2022: BC ADHESIVES 401(K) SAVINGS PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: BC ADHESIVES 401(K) SAVINGS PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: BC ADHESIVES 401(K) SAVINGS PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: BC ADHESIVES 401(K) SAVINGS PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: BC ADHESIVES 401(K) SAVINGS PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: BC ADHESIVES 401(K) SAVINGS PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: BC ADHESIVES 401(K) SAVINGS PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: BC ADHESIVES 401(K) SAVINGS PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: BC ADHESIVES 401(K) SAVINGS PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | Yes |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: BC ADHESIVES 401(K) SAVINGS PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: BC ADHESIVES 401(K) SAVINGS PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: BC ADHESIVES 401(K) SAVINGS PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: BC ADHESIVES 401(K) SAVINGS PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | Yes |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: BC ADHESIVES 401(K) SAVINGS PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 63603 |
| Policy instance | 1 |
| Insurance contract or identification number | 63603 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 63603 |
| Policy instance | 1 |
| Insurance contract or identification number | 63603 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | GA-063603 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-063603 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | GA-063603 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-063603 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | GA-063603 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-063603 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | GA-063603 |
| Policy instance | 2 |
| Insurance contract or identification number | GA-063603 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2015-08-31 | | Insurance policy end date | 2015-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498512 |
| Policy instance | 3 |
| Insurance contract or identification number | 3203498512 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3204847279 |
| Policy instance | 4 |
| Insurance contract or identification number | 3204847279 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITIES | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 35275 |
| Policy instance | 5 |
| Insurance contract or identification number | 35275 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-09-14 | | Total amount of commissions paid to insurance broker | USD $2,797 | | Total amount of fees paid to insurance company | USD $341 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,569 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | TPA COMPENSATION | | Insurance broker name | PPG RETIREMENT PLAN SERVICES, LTD. |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498710 |
| Policy instance | 6 |
| Insurance contract or identification number | 3203498710 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | |
|
| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1817859 |
| Policy instance | 1 |
| Insurance contract or identification number | E1817859 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,353 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITIES | | Commission paid to Insurance Broker | USD $3,353 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | JEROME JEDYNAK |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 35275 |
| Policy instance | 1 |
| Insurance contract or identification number | 35275 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,545 | | Total amount of fees paid to insurance company | USD $168 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,545 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 168 | | Additional information about fees paid to insurance broker | TPA COMPENSATION | | Insurance broker name | PPG RETIREMENT PLAN SERVICES, LTD. |
|
| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1817859 |
| Policy instance | 2 |
| Insurance contract or identification number | E1817859 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $8,603 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY | | Commission paid to Insurance Broker | USD $8,603 | | Insurance broker organization code? | 7 | | Insurance broker name | JEFFREY LABRI |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203688989 |
| Policy instance | 3 |
| Insurance contract or identification number | 3203688989 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498512 |
| Policy instance | 4 |
| Insurance contract or identification number | 3203498512 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498710 |
| Policy instance | 5 |
| Insurance contract or identification number | 3203498710 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3204847279 |
| Policy instance | 6 |
| Insurance contract or identification number | 3204847279 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDVIDUAL ANNUITIES |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3204847279 |
| Policy instance | 6 |
| Insurance contract or identification number | 3204847279 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDVIDUAL ANNUITIES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 35275 |
| Policy instance | 1 |
| Insurance contract or identification number | 35275 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $515 | | Total amount of fees paid to insurance company | USD $112 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $515 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 7 | | Insurance broker name | PPG RETIREMENT PLAN SERVICES, LTD. |
|
| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1817859 |
| Policy instance | 2 |
| Insurance contract or identification number | E1817859 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $8,919 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY | | Commission paid to Insurance Broker | USD $8,919 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 7 | | Insurance broker name | JEFFREY LABRI |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203688989 |
| Policy instance | 3 |
| Insurance contract or identification number | 3203688989 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498512 |
| Policy instance | 4 |
| Insurance contract or identification number | 3203498512 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498710 |
| Policy instance | 5 |
| Insurance contract or identification number | 3203498710 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1817859 |
| Policy instance | 2 |
| Insurance contract or identification number | E1817859 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,961 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY | | Commission paid to Insurance Broker | USD $7,961 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 7 | | Insurance broker name | JEFFREY LABRI |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203688989 |
| Policy instance | 3 |
| Insurance contract or identification number | 3203688989 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498512 |
| Policy instance | 4 |
| Insurance contract or identification number | 3203498512 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498710 |
| Policy instance | 5 |
| Insurance contract or identification number | 3203498710 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
|
| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3204847279 |
| Policy instance | 6 |
| Insurance contract or identification number | 3204847279 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDVIDUAL ANNUITIES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 35275 |
| Policy instance | 1 |
| Insurance contract or identification number | 35275 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $205 | | Total amount of fees paid to insurance company | USD $20 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $205 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 7 | | Insurance broker name | PPG RETIREMENT PLAN SERVICES, LTD. |
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| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 35275 |
| Policy instance | 1 |
| Insurance contract or identification number | 35275 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $181 | | Total amount of fees paid to insurance company | USD $18 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 |
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| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3204847279 |
| Policy instance | 7 |
| Insurance contract or identification number | 3204847279 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDVIDUAL ANNUITIES |
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| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498710 |
| Policy instance | 6 |
| Insurance contract or identification number | 3203498710 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
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| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203498512 |
| Policy instance | 5 |
| Insurance contract or identification number | 3203498512 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
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| METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 ) |
| Policy contract number | 3203688989 |
| Policy instance | 4 |
| Insurance contract or identification number | 3203688989 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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? | Yes | | Other information about contract | INDIVIDUAL ANNUITY |
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| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1812400 |
| Policy instance | 3 |
| Insurance contract or identification number | E1812400 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,000 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY |
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| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1817859 |
| Policy instance | 2 |
| Insurance contract or identification number | E1817859 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,630 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY |
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| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1812400 |
| Policy instance | 3 |
| Insurance contract or identification number | E1812400 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,710 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY |
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| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 35275 |
| Policy instance | 1 |
| Insurance contract or identification number | 35275 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,378 | | Total amount of fees paid to insurance company | USD $142 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 |
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| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | E1817859 |
| Policy instance | 2 |
| Insurance contract or identification number | E1817859 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,019 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Other information about contract | INDIVIDUAL ANNUITY |
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