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MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 401k Plan overview

Plan NameMID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN
Plan identification number 503

MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

MID WEST FABRICATING CO. has sponsored the creation of one or more 401k plans.

Company Name:MID WEST FABRICATING CO.
Employer identification number (EIN):314354423
NAIC Classification:332610

Additional information about MID WEST FABRICATING CO.

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0411310

More information about MID WEST FABRICATING CO.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-04-01
5032021-04-01
5032020-04-01
5032019-04-01
5032018-04-01
5032017-04-01ANN CUSTER ANN CUSTER2018-10-11
5032016-04-01ANN CUSTER ANN CUSTER2017-10-12
5032015-04-01ANN CUSTER ANN CUSTER2016-10-14
5032014-04-01ANN CUSTER ANN CUSTER2015-10-14
5032013-04-01ANN CUSTER ANN CUSTER2015-01-13
5032012-04-01ANN CUSTER ANN CUSTER2013-10-14
5032011-04-01ANN CUSTER
5032009-04-01ANN CUSTER

Plan Statistics for MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

401k plan membership statisitcs for MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Measure Date Value
2022: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01212
Total number of active participants reported on line 7a of the Form 55002022-04-01207
Total of all active and inactive participants2022-04-01207
Total participants2022-04-01207
2021: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01217
Total number of active participants reported on line 7a of the Form 55002021-04-01212
Total of all active and inactive participants2021-04-01212
Total participants2021-04-01212
2020: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01219
Total number of active participants reported on line 7a of the Form 55002020-04-01217
Total of all active and inactive participants2020-04-01217
Total participants2020-04-01217
2019: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01221
Total number of active participants reported on line 7a of the Form 55002019-04-01219
Total of all active and inactive participants2019-04-01219
Total participants2019-04-01219
2018: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01216
Total number of active participants reported on line 7a of the Form 55002018-04-01221
Total of all active and inactive participants2018-04-01221
Total participants2018-04-01221
2017: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01184
Total number of active participants reported on line 7a of the Form 55002017-04-01216
Total of all active and inactive participants2017-04-01216
Total participants2017-04-01216
2016: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01186
Total number of active participants reported on line 7a of the Form 55002016-04-01184
Total of all active and inactive participants2016-04-01184
Total participants2016-04-01184
2015: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01170
Total number of active participants reported on line 7a of the Form 55002015-04-01186
Total of all active and inactive participants2015-04-01186
Total participants2015-04-01186
2014: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01168
Total number of active participants reported on line 7a of the Form 55002014-04-01170
Total of all active and inactive participants2014-04-01170
Total participants2014-04-01170
2013: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01170
Total number of active participants reported on line 7a of the Form 55002013-04-01168
Total of all active and inactive participants2013-04-01168
Total participants2013-04-01168
2012: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01172
Total number of active participants reported on line 7a of the Form 55002012-04-01170
Total of all active and inactive participants2012-04-01170
Total participants2012-04-01170
2011: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01171
Total number of active participants reported on line 7a of the Form 55002011-04-01172
Total of all active and inactive participants2011-04-01172
Total participants2011-04-01172
2009: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01138
Total number of active participants reported on line 7a of the Form 55002009-04-01164
Total of all active and inactive participants2009-04-01164
Total participants2009-04-01164

Form 5500 Responses for MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

2022: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2021: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – InsuranceYes
2020: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – InsuranceYes
2019: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes
2018: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2009: MID WEST FABRICATING CO LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010260540000
Policy instance 1
Insurance contract or identification number000010260540000
Number of Individuals Covered207
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $1,913
Total amount of fees paid to insurance companyUSD $638
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
Welfare Benefit Premiums Paid to CarrierUSD $12,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees638
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,913
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010260540
Policy instance 1
Insurance contract or identification number000010260540
Number of Individuals Covered212
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $1,906
Total amount of fees paid to insurance companyUSD $635
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
Welfare Benefit Premiums Paid to CarrierUSD $12,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,906
Insurance broker organization code?3
Amount paid for insurance broker fees635
Additional information about fees paid to insurance brokerCONSULTING
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010260540
Policy instance 1
Insurance contract or identification number000010260540
Number of Individuals Covered217
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $2,105
Total amount of fees paid to insurance companyUSD $702
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
Welfare Benefit Premiums Paid to CarrierUSD $14,035
Amount paid for insurance broker fees702
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,105
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010260541
Policy instance 2
Insurance contract or identification number000010260541
Number of Individuals Covered219
Insurance policy start date2020-02-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $467
Total amount of fees paid to insurance companyUSD $156
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
Welfare Benefit Premiums Paid to CarrierUSD $3,114
Amount paid for insurance broker fees156
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $467
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9072573752
Policy instance 1
Insurance contract or identification number9072573752
Number of Individuals Covered209
Insurance policy start date2019-04-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $1,142
Total amount of fees paid to insurance companyUSD $668
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $11,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,142
Insurance broker organization code?3
Amount paid for insurance broker fees668
Additional information about fees paid to insurance brokerCONSULTING
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9072573752
Policy instance 1
Insurance contract or identification number9072573752
Number of Individuals Covered221
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $1,390
Total amount of fees paid to insurance companyUSD $820
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $13,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees820
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,390
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9072573752
Policy instance 1
Insurance contract or identification number9072573752
Number of Individuals Covered216
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $1,316
Total amount of fees paid to insurance companyUSD $783
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $13,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,316
Insurance broker organization code?3
Amount paid for insurance broker fees783
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker nameINSURANCE SPECIALTIES
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9072573752
Policy instance 1
Insurance contract or identification number9072573752
Number of Individuals Covered186
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $1,154
Total amount of fees paid to insurance companyUSD $702
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 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
Welfare Benefit Premiums Paid to CarrierUSD $11,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,154
Insurance broker organization code?3
Amount paid for insurance broker fees702
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker nameDAVID M BLOCK
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9072573752
Policy instance 1
Insurance contract or identification number9072573752
Number of Individuals Covered170
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $1,118
Total amount of fees paid to insurance companyUSD $684
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 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
Welfare Benefit Premiums Paid to CarrierUSD $11,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees684
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,118
Insurance broker nameMICHAEL C VALUDES
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9072573752
Policy instance 2
Insurance contract or identification number9072573752
Number of Individuals Covered168
Insurance policy start date2013-09-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $533
Total amount of fees paid to insurance companyUSD $369
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 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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $6,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $533
Insurance broker organization code?3
Amount paid for insurance broker fees369
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker nameINSURANCE SPECIALTIES INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010081899
Policy instance 1
Insurance contract or identification number000010081899
Number of Individuals Covered161
Insurance policy start date2013-04-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $421
Total amount of fees paid to insurance companyUSD $175
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 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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $3,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $421
Insurance broker organization code?3
Amount paid for insurance broker fees175
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker nameDAVID M BLOCK
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10081899
Policy instance 1
Insurance contract or identification number10081899
Number of Individuals Covered170
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $1,208
Total amount of fees paid to insurance companyUSD $507
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees503
Additional information about fees paid to insurance brokerCONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,208
Insurance broker nameMICHAEL C VALUDES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010081899
Policy instance 1
Insurance contract or identification number000010081899
Number of Individuals Covered172
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $1,274
Total amount of fees paid to insurance companyUSD $532
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,633
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 number000010081899
Policy instance 1
Insurance contract or identification number000010081899
Number of Individuals Covered171
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $1,216
Total amount of fees paid to insurance companyUSD $503
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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