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I WORKS 401(K) PLAN 401k Plan overview

Plan NameI WORKS 401(K) PLAN
Plan identification number 001

I WORKS 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ILLUMINATION WORKS, LLC has sponsored the creation of one or more 401k plans.

Company Name:ILLUMINATION WORKS, LLC
Employer identification number (EIN):204395892
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Additional information about ILLUMINATION WORKS, LLC

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 2006-03-16
Company Identification Number: 1608172
Legal Registered Office Address: 1900 KETTERING TOWER, 40 N. MAIN ST
-
DAYTON
United States of America (USA)
45423

More information about ILLUMINATION WORKS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan I WORKS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01JANET SCHREIBER2023-06-21
0012021-01-01
0012020-01-01JANET SCHREIBER2021-08-05
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01JANET ERICKSON2018-10-05
0012016-01-01CAITLIN MCCOLLUM2017-05-24 CAITLIN MCCOLLUM2017-05-24
0012015-01-01CAITLIN MCCOLLUM2016-04-10 CAITLIN MCCOLLUM2016-04-29
0012014-01-01CAITLIN MCCOLLUM2015-07-30 CAITLIN MCCOLLUM2015-07-30
0012013-01-01LIZ DOUGLAS2014-04-29 LIZ DOUGLAS2014-04-29
0012012-01-01JONATHON MITCHELL2013-05-15 JONATHON MITCHELL2013-05-15
0012011-01-01LIZ DOUGLAS2012-10-04 LIZ DOUGLAS2012-10-04
0012010-01-01JONATHON MITCHELL2011-07-27

Plan Statistics for I WORKS 401(K) PLAN

401k plan membership statisitcs for I WORKS 401(K) PLAN

Measure Date Value
2021: I WORKS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01100
Total number of active participants reported on line 7a of the Form 55002021-01-0151
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0140
Total of all active and inactive participants2021-01-0191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0191
Number of participants with account balances2021-01-0183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: I WORKS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01124
Total number of active participants reported on line 7a of the Form 55002020-01-0161
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0139
Total of all active and inactive participants2020-01-01100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01100
Number of participants with account balances2020-01-0187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: I WORKS 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01124
Total number of active participants reported on line 7a of the Form 55002019-01-0152
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0172
Total of all active and inactive participants2019-01-01124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01124
Number of participants with account balances2019-01-01119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: I WORKS 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01124
Total number of active participants reported on line 7a of the Form 55002018-01-0161
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0153
Total of all active and inactive participants2018-01-01114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01114
Number of participants with account balances2018-01-01108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0126

Financial Data on I WORKS 401(K) PLAN

Measure Date Value
2021 : I WORKS 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total transfer of assets to this plan2021-12-31$0
Total transfer of assets from this plan2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,499,462
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,265,971
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,238,664
Expenses. Certain deemed distributions of participant loans2021-12-31$175
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$636,525
Value of total assets at end of year2021-12-31$5,620,402
Value of total assets at beginning of year2021-12-31$5,386,911
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$27,132
Total interest from all sources2021-12-31$2,340
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$414,894
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$414,894
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$408,622
Participant contributions at end of year2021-12-31$27,912
Participant contributions at beginning of year2021-12-31$77,086
Participant contributions at beginning of year2021-12-31$16,169
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$20,482
Other income not declared elsewhere2021-12-31$4,433
Administrative expenses (other) incurred2021-12-31$27,132
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$233,491
Value of net assets at end of year (total assets less liabilities)2021-12-31$5,620,402
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$5,386,911
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$5,592,490
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$5,284,756
Interest on participant loans2021-12-31$2,340
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$441,270
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$207,421
Employer contributions (assets) at beginning of year2021-12-31$8,900
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,238,664
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31SWINDON SPRINGER & CO. INC. C
Accountancy firm EIN2021-12-31311339842
2020 : I WORKS 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets from this plan2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,469,824
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$1,368,959
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,363,942
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$647,727
Value of total assets at end of year2020-12-31$5,386,911
Value of total assets at beginning of year2020-12-31$5,286,046
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$5,017
Total interest from all sources2020-12-31$2,269
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$113,871
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$113,871
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$435,510
Participant contributions at end of year2020-12-31$77,086
Participant contributions at beginning of year2020-12-31$17,506
Participant contributions at end of year2020-12-31$16,169
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$92
Administrative expenses (other) incurred2020-12-31$5,017
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$100,865
Value of net assets at end of year (total assets less liabilities)2020-12-31$5,386,911
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$5,286,046
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$5,284,756
Value of interest in pooled separate accounts at beginning of year2020-12-31$5,151,429
Interest on participant loans2020-12-31$2,269
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$117,111
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$705,957
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$212,125
Employer contributions (assets) at end of year2020-12-31$8,900
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,363,942
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31Yes
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31SWINDON, SPRINGER & CO. INC. C
Accountancy firm EIN2020-12-31311339842
2019 : I WORKS 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$2,455,018
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$1,211,154
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,204,826
Expenses. Certain deemed distributions of participant loans2019-12-31$3,320
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,462,388
Value of total assets at end of year2019-12-31$5,286,046
Value of total assets at beginning of year2019-12-31$4,042,182
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$3,008
Total interest from all sources2019-12-31$1,618
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$484,048
Participant contributions at end of year2019-12-31$17,506
Participant contributions at beginning of year2019-12-31$43,275
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$752,177
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,243,864
Value of net assets at end of year (total assets less liabilities)2019-12-31$5,286,046
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$4,042,182
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$5,151,429
Value of interest in pooled separate accounts at beginning of year2019-12-31$3,920,451
Interest on participant loans2019-12-31$1,618
Interest earned on other investments2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$117,111
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$78,456
Net investment gain/loss from pooled separate accounts2019-12-31$991,012
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$226,163
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,204,826
Contract administrator fees2019-12-31$3,008
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31SWINDON, SPRINGER & CO. INC. CPAS
Accountancy firm EIN2019-12-31311339842
2018 : I WORKS 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$587,275
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$673,018
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$669,724
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$894,488
Value of total assets at end of year2018-12-31$4,042,182
Value of total assets at beginning of year2018-12-31$4,127,925
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$3,294
Total interest from all sources2018-12-31$3,117
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$3,294
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$593,466
Participant contributions at end of year2018-12-31$43,275
Participant contributions at beginning of year2018-12-31$40,177
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$24,482
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$19,570
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-85,743
Value of net assets at end of year (total assets less liabilities)2018-12-31$4,042,182
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$4,127,925
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in pooled separate accounts at end of year2018-12-31$3,920,451
Value of interest in pooled separate accounts at beginning of year2018-12-31$4,006,915
Interest on participant loans2018-12-31$2,439
Interest earned on other investments2018-12-31$678
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$78,456
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$45,059
Net investment gain/loss from pooled separate accounts2018-12-31$-310,330
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$281,452
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$11,292
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$669,724
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31SWINDON, SPRINGER & CO. INC. CPAS
Accountancy firm EIN2018-12-31311339842

Form 5500 Responses for I WORKS 401(K) PLAN

2021: I WORKS 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: I WORKS 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedYes
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: I WORKS 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: I WORKS 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-841690
Policy instance 1
Insurance contract or identification numberGA-841690
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-841690
Policy instance 1
Insurance contract or identification numberGA-841690
Number of Individuals Covered124
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,406
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2406
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-841690
Policy instance 1
Insurance contract or identification numberGA-841690
Number of Individuals Covered114
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $381
Total amount of fees paid to insurance companyUSD $1,626
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1626
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5

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