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CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 401k Plan overview

Plan NameCAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST
Plan identification number 001

CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CAROLINAS INDEPENDENT AUTOMOBI has sponsored the creation of one or more 401k plans.

Company Name:CAROLINAS INDEPENDENT AUTOMOBI
Employer identification number (EIN):237305962
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012017-01-01JOHN BRWON2018-07-13
0012016-01-01JOHN BROWN2017-06-09
0012015-01-01JOHN BROWN2016-07-26
0012014-01-01JOHN BROWN2015-06-30
0012013-01-01JOHN W BROWN
0012012-01-01ALAN B SVEDLOW2013-07-26
0012011-01-01ALAN B. SVEDLOW2012-07-27
0012009-01-01ALAN B. SVEDLOW

Plan Statistics for CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST

401k plan membership statisitcs for CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST

Measure Date Value
2022: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-01779
Total number of active participants reported on line 7a of the Form 55002022-01-01858
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-01144
Total of all active and inactive participants2022-01-011,002
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-015
Total participants2022-01-011,007
Number of participants with account balances2022-01-01860
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-01100
2021: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01607
Total number of active participants reported on line 7a of the Form 55002021-01-01695
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0181
Total of all active and inactive participants2021-01-01776
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-013
Total participants2021-01-01779
Number of participants with account balances2021-01-01680
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0147
2013: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-018
Total number of active participants reported on line 7a of the Form 55002013-01-015
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-015
Number of participants with account balances2013-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2009: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-019
Total number of active participants reported on line 7a of the Form 55002009-01-019
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-019
Number of participants with account balances2009-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST

Measure Date Value
2022 : CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$0
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$4,500
Total transfer of assets from this plan2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-478,002
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$813,177
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$737,175
Expenses. Certain deemed distributions of participant loans2022-12-31$1,678
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$3,431,874
Value of total assets at end of year2022-12-31$22,754,668
Value of total assets at beginning of year2022-12-31$24,041,347
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$74,324
Total interest from all sources2022-12-31$21,202
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$0
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$2,825,756
Participant contributions at end of year2022-12-31$376,458
Participant contributions at beginning of year2022-12-31$473,766
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$96,447
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$74,324
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-1,291,179
Value of net assets at end of year (total assets less liabilities)2022-12-31$22,754,668
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$24,041,347
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$21,420,896
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$22,989,026
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$18,781
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$2,421
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$957,314
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$578,555
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$0
Net investment gain/loss from pooled separate accounts2022-12-31$-3,931,078
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$509,671
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$737,175
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Qualified
Accountancy firm name2022-12-31WILLIAMS OVERMAN PIERCE, LLP
Accountancy firm EIN2022-12-31561031342
2021 : CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$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$6,919,537
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,852,107
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,806,618
Expenses. Certain deemed distributions of participant loans2021-12-31$8,887
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$3,830,863
Value of total assets at end of year2021-12-31$24,032,460
Value of total assets at beginning of year2021-12-31$18,965,030
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$36,602
Total interest from all sources2021-12-31$33,323
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31No
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$2,652,751
Participant contributions at end of year2021-12-31$464,879
Participant contributions at beginning of year2021-12-31$493,873
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$619,649
Other income not declared elsewhere2021-12-31$20,908
Administrative expenses (other) incurred2021-12-31$36,602
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$5,067,430
Value of net assets at end of year (total assets less liabilities)2021-12-31$24,032,460
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$18,965,030
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$22,989,026
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$17,402,854
Interest on participant loans2021-12-31$24,992
Interest earned on other investments2021-12-31$8,331
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$578,555
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$1,068,303
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Net investment gain/loss from pooled separate accounts2021-12-31$3,034,443
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 contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$558,463
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,806,618
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 name2021-12-31WILLIAMS OVERMAN PIERCE, LLP
Accountancy firm EIN2021-12-31561031342
2013 : CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$-29,592
Expenses. Total of all expenses incurred2013-12-31$0
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$59,038
Total plan assets at beginning of year2013-12-31$88,630
Value of fidelity bond covering the plan2013-12-31$20,000
Total contributions received or receivable from participants2013-12-31$1,930
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$-31,522
Net income (gross income less expenses)2013-12-31$-29,592
Net plan assets at end of year (total assets less liabilities)2013-12-31$59,038
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$88,630
Total contributions received or receivable from employer(s)2013-12-31$0
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$0
2010 : CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$60,323
Expenses. Total of all expenses incurred2010-12-31$12,942
Benefits paid (including direct rollovers)2010-12-31$12,586
Total plan assets at end of year2010-12-31$228,561
Total plan assets at beginning of year2010-12-31$181,180
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$32,538
Expenses. Other expenses not covered elsewhere2010-12-31$356
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$27,785
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$47,381
Net plan assets at end of year (total assets less liabilities)2010-12-31$228,561
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$181,180
Total contributions received or receivable from employer(s)2010-12-31$0
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$0
Amount contributed by the employer to the plan for this plan year2010-12-31$0
2009 : CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$0
Amount contributed by the employer to the plan for this plan year2009-12-31$0

Form 5500 Responses for CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST

2022: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Submission has been amendedYes
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 – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2013: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2009: CAROLINAS INDEPENDENT AUTOMOBI 401 K PROFIT SHARING PLAN TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number578050K
Policy instance 1
Insurance contract or identification number578050K
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number578050K
Policy instance 1
Insurance contract or identification number578050K
Number of Individuals Covered779
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 Administration1
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
RLI INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberLFM0030147
Policy instance 1
Insurance contract or identification numberLFM0030147
Number of Individuals Covered5
Insurance policy start date2013-10-01
Insurance policy end date2016-10-01
Total amount of commissions paid to insurance brokerUSD $28
Total amount of fees paid to insurance companyUSD $110
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
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

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