SMALL'S SAND & GRAVEL, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN
401k plan membership statisitcs for SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2015: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 0 |
| Total participants | 2015-09-01 | 0 |
| 2014: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 44 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 40 |
| Total of all active and inactive participants | 2014-09-01 | 40 |
| 2013: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 48 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 44 |
| Total of all active and inactive participants | 2013-09-01 | 44 |
| 2012: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 43 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 44 |
| Total of all active and inactive participants | 2012-09-01 | 44 |
| 2011: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 44 |
| Number of retired or separated participants receiving benefits | 2011-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-09-01 | 0 |
| Total of all active and inactive participants | 2011-09-01 | 44 |
| Measure | Date | Value |
|---|
| 2016 : SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2016 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2016-08-31 | $40,230 |
| Total income from all sources | 2016-08-31 | $3,502 |
| Expenses. Total of all expenses incurred | 2016-08-31 | $57,880 |
| Benefits paid (including direct rollovers) | 2016-08-31 | $54,153 |
| Total plan assets at end of year | 2016-08-31 | $1,921 |
| Total plan assets at beginning of year | 2016-08-31 | $96,529 |
| Value of fidelity bond covering the plan | 2016-08-31 | $150,000 |
| Expenses. Other expenses not covered elsewhere | 2016-08-31 | $2,167 |
| Net income (gross income less expenses) | 2016-08-31 | $-54,378 |
| Net plan assets at end of year (total assets less liabilities) | 2016-08-31 | $1,921 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-08-31 | $56,299 |
| Total contributions received or receivable from employer(s) | 2016-08-31 | $3,502 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-08-31 | $1,560 |
| 2015 : SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-08-31 | $40,230 |
| Total plan liabilities at beginning of year | 2015-08-31 | $188,589 |
| Total income from all sources | 2015-08-31 | $663,480 |
| Expenses. Total of all expenses incurred | 2015-08-31 | $677,238 |
| Benefits paid (including direct rollovers) | 2015-08-31 | $616,730 |
| Total plan assets at end of year | 2015-08-31 | $96,529 |
| Total plan assets at beginning of year | 2015-08-31 | $258,646 |
| Value of fidelity bond covering the plan | 2015-08-31 | $150,000 |
| Total contributions received or receivable from participants | 2015-08-31 | $94,904 |
| Expenses. Other expenses not covered elsewhere | 2015-08-31 | $4 |
| Net income (gross income less expenses) | 2015-08-31 | $-13,758 |
| Net plan assets at end of year (total assets less liabilities) | 2015-08-31 | $56,299 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-08-31 | $70,057 |
| Total contributions received or receivable from employer(s) | 2015-08-31 | $568,576 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-08-31 | $60,504 |
| 2014 : SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-08-31 | $188,589 |
| Total plan liabilities at beginning of year | 2014-08-31 | $1,292 |
| Total income from all sources | 2014-08-31 | $469,802 |
| Expenses. Total of all expenses incurred | 2014-08-31 | $455,310 |
| Benefits paid (including direct rollovers) | 2014-08-31 | $423,173 |
| Total plan assets at end of year | 2014-08-31 | $258,646 |
| Total plan assets at beginning of year | 2014-08-31 | $56,857 |
| Value of fidelity bond covering the plan | 2014-08-31 | $150,000 |
| Total contributions received or receivable from participants | 2014-08-31 | $84,488 |
| Net income (gross income less expenses) | 2014-08-31 | $14,492 |
| Net plan assets at end of year (total assets less liabilities) | 2014-08-31 | $70,057 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-08-31 | $55,565 |
| Total contributions received or receivable from employer(s) | 2014-08-31 | $385,314 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-08-31 | $32,137 |
| 2013 : SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-08-31 | $1,292 |
| Total plan liabilities at beginning of year | 2013-08-31 | $3,811 |
| Total income from all sources | 2013-08-31 | $411,890 |
| Expenses. Total of all expenses incurred | 2013-08-31 | $393,598 |
| Benefits paid (including direct rollovers) | 2013-08-31 | $368,872 |
| Total plan assets at end of year | 2013-08-31 | $56,857 |
| Total plan assets at beginning of year | 2013-08-31 | $41,084 |
| Value of fidelity bond covering the plan | 2013-08-31 | $150,000 |
| Total contributions received or receivable from participants | 2013-08-31 | $74,514 |
| Net income (gross income less expenses) | 2013-08-31 | $18,292 |
| Net plan assets at end of year (total assets less liabilities) | 2013-08-31 | $55,565 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-08-31 | $37,273 |
| Total contributions received or receivable from employer(s) | 2013-08-31 | $337,376 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-08-31 | $24,726 |
| 2012 : SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-08-31 | $3,811 |
| Total plan liabilities at beginning of year | 2012-08-31 | $0 |
| Total income from all sources | 2012-08-31 | $383,171 |
| Expenses. Total of all expenses incurred | 2012-08-31 | $374,539 |
| Benefits paid (including direct rollovers) | 2012-08-31 | $351,451 |
| Total plan assets at end of year | 2012-08-31 | $41,084 |
| Total plan assets at beginning of year | 2012-08-31 | $28,641 |
| Value of fidelity bond covering the plan | 2012-08-31 | $100,000 |
| Total contributions received or receivable from participants | 2012-08-31 | $67,372 |
| Net income (gross income less expenses) | 2012-08-31 | $8,632 |
| Net plan assets at end of year (total assets less liabilities) | 2012-08-31 | $37,273 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-08-31 | $28,641 |
| Total contributions received or receivable from employer(s) | 2012-08-31 | $315,799 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-08-31 | $23,088 |
| 2011 : SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-08-31 | $0 |
| Total plan liabilities at beginning of year | 2011-08-31 | $0 |
| Total income from all sources | 2011-08-31 | $323,940 |
| Expenses. Total of all expenses incurred | 2011-08-31 | $295,299 |
| Benefits paid (including direct rollovers) | 2011-08-31 | $274,276 |
| Total plan assets at end of year | 2011-08-31 | $28,641 |
| Total plan assets at beginning of year | 2011-08-31 | $0 |
| Value of fidelity bond covering the plan | 2011-08-31 | $100,000 |
| Total contributions received or receivable from participants | 2011-08-31 | $52,565 |
| Net income (gross income less expenses) | 2011-08-31 | $28,641 |
| Net plan assets at end of year (total assets less liabilities) | 2011-08-31 | $28,641 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-08-31 | $0 |
| Total contributions received or receivable from employer(s) | 2011-08-31 | $271,375 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-08-31 | $21,023 |
| 2015: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Submission has been amended | No |
| 2015-09-01 | This submission is the final filing | No |
| 2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-09-01 | Plan is a collectively bargained plan | No |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan funding arrangement – Trust | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement - Trust | Yes |
| 2014: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | No |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – Trust | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement - Trust | Yes |
| 2013: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Submission has been amended | No |
| 2013-09-01 | This submission is the final filing | No |
| 2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-09-01 | Plan is a collectively bargained plan | No |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – Trust | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement - Trust | Yes |
| 2012: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Submission has been amended | No |
| 2012-09-01 | This submission is the final filing | No |
| 2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-09-01 | Plan is a collectively bargained plan | No |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – Trust | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement - Trust | Yes |
| 2011: SMALL'S SAND & GRAVEL, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Submission has been amended | No |
| 2011-09-01 | This submission is the final filing | No |
| 2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-09-01 | Plan is a collectively bargained plan | No |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – Trust | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement - Trust | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1140584 |
| Policy instance | 2 |
| Insurance contract or identification number | 1140584 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $350 | | 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? | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $148 | | Insurance broker organization code? | 3 | | Insurance broker name | COST REDUCTION ANYALYSTS, LTD. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-47-707 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-47-707 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $105 | | 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? | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $135,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70 | | Insurance broker organization code? | 3 | | Insurance broker name | BAC AGENCY, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1140584 |
| Policy instance | 2 |
| Insurance contract or identification number | 1140584 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $344 | | 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? | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $172 | | Insurance broker organization code? | 3 | | Insurance broker name | BAC AGENCY, INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-47-707 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-47-707 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $27,132 | | 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? | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $180,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,088 | | Insurance broker organization code? | 3 | | Insurance broker name | BAC AGENCY, INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-47-707 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-47-707 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $27,938 | | 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? | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $186,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,625 | | Insurance broker organization code? | 3 | | Insurance broker name | BAC AGENCY, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1140584 |
| Policy instance | 2 |
| Insurance contract or identification number | 1140584 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $346 | | 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? | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,725 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $173 | | Insurance broker organization code? | 3 | | Insurance broker name | BAC AGENCY, INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-47-707 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-47-707 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $27,603 | | 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? | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $184,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1140584 |
| Policy instance | 2 |
| Insurance contract or identification number | 1140584 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $266 | | 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? | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,682 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-47-707 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-47-707 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $23,180 | | 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? | 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 | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $154,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1140584 |
| Policy instance | 2 |
| Insurance contract or identification number | 1140584 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $105 | | 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? | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
