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401k Plan overview

Plan NameIVC INDUSTRIAL COATINGS, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 501

IVC INDUSTRIAL COATINGS, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    I.V.C. INDUSTRIAL COATINGS, INC. has sponsored the creation of one or more 401k plans.

    Company Name:I.V.C. INDUSTRIAL COATINGS, INC.
    Employer identification number (EIN):350414200
    NAIC Classification:325500

    Additional information about I.V.C. INDUSTRIAL COATINGS, INC.

    Jurisdiction of Incorporation: Texas Secretary of State
    Incorporation Date: 2016-09-02
    Company Identification Number: 0802535271
    Legal Registered Office Address: 211 E 7TH ST STE 620

    AUSTIN
    United States of America (USA)
    78701

    More information about I.V.C. INDUSTRIAL COATINGS, INC.

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan IVC INDUSTRIAL COATINGS, INC. EMPLOYEE BENEFIT PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012015-01-01JAMES HOLTEL JAMES HOLTEL2016-06-24
    5012014-01-01RACHELLE MINTER RACHELLE MINTER2015-06-26
    5012013-01-01STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE2014-10-12
    5012012-01-01RACHELLE MINTER RACHELLE MINTER2015-06-26
    5012011-01-01RACHELLE MINTER RACHELLE MINTER2015-06-26
    5012010-01-01RACHELLE MINTER RACHELLE MINTER2015-06-26
    5012009-01-01RACHELLE MINTER RACHELLE MINTER2015-06-26

    Plan Statistics for IVC INDUSTRIAL COATINGS, INC. EMPLOYEE BENEFIT PLAN

    401k plan membership statisitcs for IVC INDUSTRIAL COATINGS, INC. EMPLOYEE BENEFIT PLAN

    Measure Date Value
    2015
    Total participants, beginning-of-year2015-01-01249
    Total number of active participants reported on line 7a of the Form 55002015-01-010
    Number of retired or separated participants receiving benefits2015-01-010
    Number of other retired or separated participants entitled to future benefits2015-01-010
    Total of all active and inactive participants2015-01-010
    2014
    Total participants, beginning-of-year2014-01-01239
    Total number of active participants reported on line 7a of the Form 55002014-01-01245
    Number of retired or separated participants receiving benefits2014-01-011
    Number of other retired or separated participants entitled to future benefits2014-01-010
    Total of all active and inactive participants2014-01-01246
    2013
    Total participants, beginning-of-year2013-01-01260
    Total number of active participants reported on line 7a of the Form 55002013-01-01266
    Number of retired or separated participants receiving benefits2013-01-011
    Total of all active and inactive participants2013-01-01267
    Total participants2013-01-01267
    2012
    Total participants, beginning-of-year2012-01-01195
    Total number of active participants reported on line 7a of the Form 55002012-01-01226
    Number of retired or separated participants receiving benefits2012-01-011
    Number of other retired or separated participants entitled to future benefits2012-01-010
    Total of all active and inactive participants2012-01-01227
    2011
    Total participants, beginning-of-year2011-01-01159
    Total number of active participants reported on line 7a of the Form 55002011-01-01195
    Number of retired or separated participants receiving benefits2011-01-010
    Number of other retired or separated participants entitled to future benefits2011-01-010
    Total of all active and inactive participants2011-01-01195
    2010
    Total participants, beginning-of-year2010-01-01207
    Total number of active participants reported on line 7a of the Form 55002010-01-01156
    Number of retired or separated participants receiving benefits2010-01-013
    Number of other retired or separated participants entitled to future benefits2010-01-010
    Total of all active and inactive participants2010-01-01159
    2009
    Total participants, beginning-of-year2009-01-01108
    Total number of active participants reported on line 7a of the Form 55002009-01-01204
    Number of retired or separated participants receiving benefits2009-01-013
    Number of other retired or separated participants entitled to future benefits2009-01-010
    Total of all active and inactive participants2009-01-01207

    Form 5500 Responses

    2015
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01Submission has been amendedNo
    2015-01-01This submission is the final filingYes
    2015-01-01This return/report is a short plan year return/report (less than 12 months)No
    2015-01-01Plan is a collectively bargained planNo
    2015-01-01Plan funding arrangement – InsuranceYes
    2015-01-01Plan funding arrangement – General assets of the sponsorYes
    2015-01-01Plan benefit arrangement – InsuranceYes
    2015-01-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-01-01Type of plan entitySingle employer plan
    2014-01-01Submission has been amendedNo
    2014-01-01This submission is the final filingNo
    2014-01-01This return/report is a short plan year return/report (less than 12 months)No
    2014-01-01Plan is a collectively bargained planNo
    2014-01-01Plan funding arrangement – InsuranceYes
    2014-01-01Plan funding arrangement – General assets of the sponsorYes
    2014-01-01Plan benefit arrangement – InsuranceYes
    2014-01-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01First time form 5500 has been submittedYes
    2013-01-01Plan funding arrangement – InsuranceYes
    2013-01-01Plan funding arrangement – General assets of the sponsorYes
    2013-01-01Plan benefit arrangement – InsuranceYes
    2013-01-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Submission has been amendedNo
    2012-01-01This submission is the final filingNo
    2012-01-01This return/report is a short plan year return/report (less than 12 months)No
    2012-01-01Plan is a collectively bargained planNo
    2012-01-01Plan funding arrangement – InsuranceYes
    2012-01-01Plan funding arrangement – General assets of the sponsorYes
    2012-01-01Plan benefit arrangement – InsuranceYes
    2012-01-01Plan benefit arrangement – General assets of the sponsorYes
    2011
    2011-01-01Type of plan entitySingle employer plan
    2011-01-01Submission has been amendedNo
    2011-01-01This submission is the final filingNo
    2011-01-01This return/report is a short plan year return/report (less than 12 months)No
    2011-01-01Plan is a collectively bargained planNo
    2011-01-01Plan funding arrangement – InsuranceYes
    2011-01-01Plan funding arrangement – General assets of the sponsorYes
    2011-01-01Plan benefit arrangement – InsuranceYes
    2011-01-01Plan benefit arrangement – General assets of the sponsorYes
    2010
    2010-01-01Type of plan entitySingle employer plan
    2010-01-01Submission has been amendedNo
    2010-01-01This submission is the final filingNo
    2010-01-01This return/report is a short plan year return/report (less than 12 months)No
    2010-01-01Plan is a collectively bargained planNo
    2010-01-01Plan funding arrangement – InsuranceYes
    2010-01-01Plan funding arrangement – General assets of the sponsorYes
    2010-01-01Plan benefit arrangement – InsuranceYes
    2010-01-01Plan benefit arrangement – General assets of the sponsorYes
    2009
    2009-01-01Type of plan entitySingle employer plan
    2009-01-01First time form 5500 has been submittedYes
    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 – InsuranceYes
    2009-01-01Plan funding arrangement – General assets of the sponsorYes
    2009-01-01Plan benefit arrangement – InsuranceYes
    2009-01-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601506
    Policy instance 1
    Insurance contract or identification numberSGD601506
    Number of Individuals Covered216
    Insurance policy start date2014-12-01
    Insurance policy end date2015-11-30
    Total amount of commissions paid to insurance brokerUSD $3,120
    Total amount of fees paid to insurance companyUSD $0
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $23,695
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,120
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number622100 S001
    Policy instance 2
    Insurance contract or identification number622100 S001
    Number of Individuals Covered148
    Insurance policy start date2014-11-01
    Insurance policy end date2015-10-31
    Total amount of commissions paid to insurance brokerUSD $47,900
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $646,868
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $47,900
    Insurance broker organization code?3
    Insurance broker nameDANIEL C. APPEL
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
    Policy contract number30005506
    Policy instance 3
    Insurance contract or identification number30005506
    Number of Individuals Covered213
    Insurance policy start date2014-12-01
    Insurance policy end date2015-11-30
    Total amount of commissions paid to insurance brokerUSD $1,530
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $35,367
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,530
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGM601613
    Policy instance 4
    Insurance contract or identification numberSGM601613
    Number of Individuals Covered256
    Insurance policy start date2014-12-01
    Insurance policy end date2015-11-30
    Total amount of commissions paid to insurance brokerUSD $3,697
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $69,688
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,697
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSOK600938
    Policy instance 5
    Insurance contract or identification numberSOK600938
    Number of Individuals Covered256
    Insurance policy start date2014-12-01
    Insurance policy end date2015-11-30
    Total amount of commissions paid to insurance brokerUSD $188
    Total amount of fees paid to insurance companyUSD $0
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $1,255
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $188
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00417329
    Policy instance 6
    Insurance contract or identification number00417329
    Number of Individuals Covered205
    Insurance policy start date2014-12-01
    Insurance policy end date2015-11-30
    Total amount of commissions paid to insurance brokerUSD $4,396
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $160,178
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,396
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INSURANCE
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601505
    Policy instance 7
    Insurance contract or identification numberSGD601505
    Number of Individuals Covered219
    Insurance policy start date2014-12-01
    Insurance policy end date2015-11-30
    Total amount of commissions paid to insurance brokerUSD $2,980
    Total amount of fees paid to insurance companyUSD $0
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $40,601
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,980
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
    Policy contract number30005506
    Policy instance 3
    Insurance contract or identification number30005506
    Number of Individuals Covered212
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $1,562
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $36,453
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,562
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGM601613
    Policy instance 4
    Insurance contract or identification numberSGM601613
    Number of Individuals Covered245
    Insurance policy start date2013-12-01
    Insurance policy end date2014-11-30
    Total amount of commissions paid to insurance brokerUSD $3,669
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $66,898
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,669
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSOK600938
    Policy instance 5
    Insurance contract or identification numberSOK600938
    Number of Individuals Covered245
    Insurance policy start date2013-12-01
    Insurance policy end date2014-11-30
    Total amount of commissions paid to insurance brokerUSD $193
    Total amount of fees paid to insurance companyUSD $0
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $1,287
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $193
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00417329
    Policy instance 6
    Insurance contract or identification number00417329
    Number of Individuals Covered212
    Insurance policy start date2013-12-01
    Insurance policy end date2014-11-30
    Total amount of commissions paid to insurance brokerUSD $4,083
    Total amount of fees paid to insurance companyUSD $5,309
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $138,884
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,083
    Amount paid for insurance broker fees5309
    Additional information about fees paid to insurance brokerTOTAL FEES PAID
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INSURANCE
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601505
    Policy instance 7
    Insurance contract or identification numberSGD601505
    Number of Individuals Covered214
    Insurance policy start date2013-12-01
    Insurance policy end date2014-11-30
    Total amount of commissions paid to insurance brokerUSD $2,982
    Total amount of fees paid to insurance companyUSD $0
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $40,648
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,982
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number622100 S001
    Policy instance 2
    Insurance contract or identification number622100 S001
    Number of Individuals Covered173
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $22,066
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $664,635
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $22,066
    Insurance broker organization code?3
    Insurance broker nameDANIEL C. APPEL
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601506
    Policy instance 1
    Insurance contract or identification numberSGD601506
    Number of Individuals Covered211
    Insurance policy start date2013-12-01
    Insurance policy end date2014-11-30
    Total amount of commissions paid to insurance brokerUSD $3,125
    Total amount of fees paid to insurance companyUSD $0
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $23,745
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,125
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00417329
    Policy instance 6
    Insurance contract or identification number00417329
    Number of Individuals Covered203
    Insurance policy start date2012-12-01
    Insurance policy end date2013-11-30
    Total amount of commissions paid to insurance brokerUSD $4,094
    Total amount of fees paid to insurance companyUSD $7,213
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $139,588
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,094
    Amount paid for insurance broker fees7213
    Additional information about fees paid to insurance brokerOTHER BROKER FEES
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSDK600938
    Policy instance 5
    Insurance contract or identification numberSDK600938
    Number of Individuals Covered266
    Insurance policy start date2012-12-01
    Insurance policy end date2013-11-30
    Total amount of commissions paid to insurance brokerUSD $182
    Other welfare benefits providedA D & D
    Welfare Benefit Premiums Paid to CarrierUSD $1,213
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $182
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601506
    Policy instance 3
    Insurance contract or identification numberSGD601506
    Number of Individuals Covered233
    Insurance policy start date2012-12-01
    Insurance policy end date2013-11-30
    Total amount of commissions paid to insurance brokerUSD $2,989
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $22,392
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,989
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
    Policy contract number30005506
    Policy instance 1
    Insurance contract or identification number30005506
    Number of Individuals Covered211
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $1,494
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $32,848
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,494
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601505
    Policy instance 2
    Insurance contract or identification numberSGD601505
    Number of Individuals Covered233
    Insurance policy start date2012-12-01
    Insurance policy end date2013-11-30
    Total amount of commissions paid to insurance brokerUSD $2,871
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $38,423
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,871
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGM601613
    Policy instance 4
    Insurance contract or identification numberSGM601613
    Number of Individuals Covered266
    Insurance policy start date2012-12-01
    Insurance policy end date2013-11-30
    Total amount of commissions paid to insurance brokerUSD $3,692
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $69,179
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,692
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGM601613
    Policy instance 1
    Insurance contract or identification numberSGM601613
    Number of Individuals Covered226
    Insurance policy start date2011-12-01
    Insurance policy end date2012-11-30
    Total amount of commissions paid to insurance brokerUSD $3,789
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $62,047
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,789
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601506
    Policy instance 5
    Insurance contract or identification numberSGD601506
    Number of Individuals Covered190
    Insurance policy start date2011-12-01
    Insurance policy end date2012-11-30
    Total amount of commissions paid to insurance brokerUSD $2,801
    Total amount of fees paid to insurance companyUSD $0
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $20,507
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,801
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601505
    Policy instance 3
    Insurance contract or identification numberSGD601505
    Number of Individuals Covered194
    Insurance policy start date2011-12-01
    Insurance policy end date2012-11-30
    Total amount of commissions paid to insurance brokerUSD $2,721
    Total amount of fees paid to insurance companyUSD $0
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $35,415
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,721
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INC.
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSOK600938
    Policy instance 4
    Insurance contract or identification numberSOK600938
    Number of Individuals Covered226
    Insurance policy start date2011-12-01
    Insurance policy end date2012-11-30
    Total amount of commissions paid to insurance brokerUSD $171
    Total amount of fees paid to insurance companyUSD $0
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $1,139
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $171
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00417329
    Policy instance 6
    Insurance contract or identification number00417329
    Number of Individuals Covered197
    Insurance policy start date2011-12-01
    Insurance policy end date2012-11-30
    Total amount of commissions paid to insurance brokerUSD $3,954
    Total amount of fees paid to insurance companyUSD $4,715
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $130,266
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,954
    Amount paid for insurance broker fees4715
    Additional information about fees paid to insurance brokerTOTAL FEES PAID
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL INSURANCE
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
    Policy contract number30005506
    Policy instance 7
    Insurance contract or identification number30005506
    Number of Individuals Covered191
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $1,446
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $30,557
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,446
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number622100 S001
    Policy instance 2
    Insurance contract or identification number622100 S001
    Number of Individuals Covered160
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $19,187
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $502,614
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,187
    Insurance broker organization code?3
    Insurance broker nameDANIEL C. APPEL
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
    Policy contract number30005506
    Policy instance 2
    Insurance contract or identification number30005506
    Number of Individuals Covered173
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $1,280
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $25,132
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGM601613
    Policy instance 3
    Insurance contract or identification numberSGM601613
    Number of Individuals Covered195
    Insurance policy start date2010-12-01
    Insurance policy end date2011-11-30
    Total amount of commissions paid to insurance brokerUSD $3,639
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $52,786
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601506
    Policy instance 4
    Insurance contract or identification numberSGD601506
    Number of Individuals Covered162
    Insurance policy start date2010-12-01
    Insurance policy end date2011-11-30
    Total amount of commissions paid to insurance brokerUSD $2,719
    Total amount of fees paid to insurance companyUSD $0
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $19,663
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSGD601505
    Policy instance 5
    Insurance contract or identification numberSGD601505
    Number of Individuals Covered164
    Insurance policy start date2010-12-01
    Insurance policy end date2011-11-30
    Total amount of commissions paid to insurance brokerUSD $2,647
    Total amount of fees paid to insurance companyUSD $0
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $33,931
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number622100 S001
    Policy instance 1
    Insurance contract or identification number622100 S001
    Number of Individuals Covered146
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $17,726
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $468,919
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00417329
    Policy instance 6
    Insurance contract or identification number00417329
    Number of Individuals Covered163
    Insurance policy start date2010-12-01
    Insurance policy end date2011-11-30
    Total amount of commissions paid to insurance brokerUSD $4,259
    Total amount of fees paid to insurance companyUSD $4,644
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $109,926
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
    Policy contract numberSOK600938
    Policy instance 7
    Insurance contract or identification numberSOK600938
    Number of Individuals Covered195
    Insurance policy start date2010-12-01
    Insurance policy end date2011-11-30
    Total amount of commissions paid to insurance brokerUSD $164
    Total amount of fees paid to insurance companyUSD $0
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $1,096
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number622100 S001
    Policy instance 1
    Insurance contract or identification number622100 S001
    Number of Individuals Covered132
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $15,317
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $442,893
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,317
    Insurance broker organization code?3
    Insurance broker nameDANIEL C. APPEL
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00417329
    Policy instance 2
    Insurance contract or identification number00417329
    Number of Individuals Covered150
    Insurance policy start date2009-12-01
    Insurance policy end date2010-11-30
    Total amount of commissions paid to insurance brokerUSD $3,725
    Total amount of fees paid to insurance companyUSD $3,354
    Dental Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $98,746
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,725
    Amount paid for insurance broker fees3354
    Additional information about fees paid to insurance brokerTOTAL FEES PAID
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
    Policy contract number30005506
    Policy instance 3
    Insurance contract or identification number30005506
    Number of Individuals Covered156
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $1,202
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $22,885
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,202
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00417329
    Policy instance 1
    Insurance contract or identification number00417329
    Number of Individuals Covered204
    Insurance policy start date2008-12-01
    Insurance policy end date2009-11-30
    Total amount of commissions paid to insurance brokerUSD $16,470
    Total amount of fees paid to insurance companyUSD $6,495
    Dental Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $214,632
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $16,391
    Amount paid for insurance broker fees6495
    Additional information about fees paid to insurance brokerTOTAL FEES PAID
    Insurance broker organization code?3
    Insurance broker nameHORIZON PLANNING GROUP OF MICHIANA
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
    Policy contract number30005506
    Policy instance 2
    Insurance contract or identification number30005506
    Number of Individuals Covered143
    Insurance policy start date2009-01-01
    Insurance policy end date2009-12-31
    Total amount of commissions paid to insurance brokerUSD $1,134
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $20,164
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,134
    Insurance broker organization code?3
    Insurance broker nameGREGORY & APPEL, INC.
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number622100 S001
    Policy instance 3
    Insurance contract or identification number622100 S001
    Number of Individuals Covered143
    Insurance policy start date2009-01-01
    Insurance policy end date2009-12-31
    Total amount of commissions paid to insurance brokerUSD $18,179
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $523,747
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $18,179
    Insurance broker organization code?3
    Insurance broker nameDANIEL C. APPEL

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