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| Plan Name | SELTZER INSURANCE AGENCY, INC. EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SELTZER INSURANCE AGENCY, INC. |
| Employer identification number (EIN): | 232191895 |
| NAIC Classification: | 524210 |
| NAIC Description: | Insurance Agencies and Brokerages |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-11-01 |
| Measure | Date | Value |
|---|---|---|
| 2019: SELTZER INSURANCE AGENCY, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-11-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 40 |
| Number of retired or separated participants receiving benefits | 2019-11-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2019-11-01 | 0 |
| Total of all active and inactive participants | 2019-11-01 | 43 |
| Measure | Date | Value |
|---|---|---|
| 2020 : SELTZER INSURANCE AGENCY, INC. EMPLOYEE BENEFIT PLAN 2020 401k financial data | ||
| Total plan liabilities at end of year | 2020-10-31 | $137,074 |
| Total plan liabilities at beginning of year | 2020-10-31 | $0 |
| Total income from all sources | 2020-10-31 | $387,584 |
| Expenses. Total of all expenses incurred | 2020-10-31 | $524,330 |
| Benefits paid (including direct rollovers) | 2020-10-31 | $368,986 |
| Total plan assets at end of year | 2020-10-31 | $328 |
| Total plan assets at beginning of year | 2020-10-31 | $0 |
| Value of fidelity bond covering the plan | 2020-10-31 | $400,000 |
| Total contributions received or receivable from participants | 2020-10-31 | $61,311 |
| Expenses. Other expenses not covered elsewhere | 2020-10-31 | $127,760 |
| Contributions received from other sources (not participants or employers) | 2020-10-31 | $20,205 |
| Other income received | 2020-10-31 | $91 |
| Net income (gross income less expenses) | 2020-10-31 | $-136,746 |
| Net plan assets at end of year (total assets less liabilities) | 2020-10-31 | $-136,746 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-10-31 | $0 |
| Total contributions received or receivable from employer(s) | 2020-10-31 | $305,977 |
| Value of corrective distributions | 2020-10-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-10-31 | $27,584 |
| 2019: SELTZER INSURANCE AGENCY, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | First time form 5500 has been submitted | Yes |
| 2019-11-01 | Submission has been amended | No |
| 2019-11-01 | This submission is the final filing | No |
| 2019-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-11-01 | Plan is a collectively bargained plan | No |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan funding arrangement – Trust | Yes |
| 2019-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement - Trust | Yes |
| 2019-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 935698 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 30500487 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 567285 0001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 567285 0800 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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