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LIFE AD&D DEPENDENT LIFE 401k Plan overview

Plan NameLIFE AD&D DEPENDENT LIFE
Plan identification number 502

LIFE AD&D DEPENDENT LIFE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

JASPER SEATING COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:JASPER SEATING COMPANY, INC.
Employer identification number (EIN):350420370
NAIC Classification:337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE AD&D DEPENDENT LIFE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2018-10-15
5022016-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2017-10-06
5022015-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2016-10-17
5022014-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2015-10-13
5022013-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2014-10-13
5022012-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2013-10-11
5022011-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2012-07-27
5022009-01-01MICHAEL J ELLIOTT MICHAEL J ELLIOTT2010-07-30

Plan Statistics for LIFE AD&D DEPENDENT LIFE

401k plan membership statisitcs for LIFE AD&D DEPENDENT LIFE

Measure Date Value
2021: LIFE AD&D DEPENDENT LIFE 2021 401k membership
Total participants, beginning-of-year2021-01-01838
Total number of active participants reported on line 7a of the Form 55002021-01-01846
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01846
2020: LIFE AD&D DEPENDENT LIFE 2020 401k membership
Total participants, beginning-of-year2020-01-011,097
Total number of active participants reported on line 7a of the Form 55002020-01-01838
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01838
2019: LIFE AD&D DEPENDENT LIFE 2019 401k membership
Total participants, beginning-of-year2019-01-011,125
Total number of active participants reported on line 7a of the Form 55002019-01-011,097
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-011,097
2018: LIFE AD&D DEPENDENT LIFE 2018 401k membership
Total participants, beginning-of-year2018-01-011,125
Total number of active participants reported on line 7a of the Form 55002018-01-011,125
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-011,125
2017: LIFE AD&D DEPENDENT LIFE 2017 401k membership
Total participants, beginning-of-year2017-01-01856
Total number of active participants reported on line 7a of the Form 55002017-01-01949
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01949
2016: LIFE AD&D DEPENDENT LIFE 2016 401k membership
Total participants, beginning-of-year2016-01-01868
Total number of active participants reported on line 7a of the Form 55002016-01-01856
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01856
2015: LIFE AD&D DEPENDENT LIFE 2015 401k membership
Total participants, beginning-of-year2015-01-01771
Total number of active participants reported on line 7a of the Form 55002015-01-01868
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 participants2015-01-01868
2014: LIFE AD&D DEPENDENT LIFE 2014 401k membership
Total participants, beginning-of-year2014-01-01764
Total number of active participants reported on line 7a of the Form 55002014-01-01771
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01771
2013: LIFE AD&D DEPENDENT LIFE 2013 401k membership
Total participants, beginning-of-year2013-01-01555
Total number of active participants reported on line 7a of the Form 55002013-01-01764
Total of all active and inactive participants2013-01-01764
2012: LIFE AD&D DEPENDENT LIFE 2012 401k membership
Total participants, beginning-of-year2012-01-01529
Total number of active participants reported on line 7a of the Form 55002012-01-01555
Total of all active and inactive participants2012-01-01555
2011: LIFE AD&D DEPENDENT LIFE 2011 401k membership
Total participants, beginning-of-year2011-01-01456
Total number of active participants reported on line 7a of the Form 55002011-01-01529
Total of all active and inactive participants2011-01-01529
2009: LIFE AD&D DEPENDENT LIFE 2009 401k membership
Total participants, beginning-of-year2009-01-01629
Total number of active participants reported on line 7a of the Form 55002009-01-01458
Total of all active and inactive participants2009-01-01458

Financial Data on LIFE AD&D DEPENDENT LIFE

Measure Date Value
2021 : LIFE AD&D DEPENDENT LIFE 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$569,935
Total of all expenses incurred2021-12-31$569,935
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$569,935
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$569,935
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net assets at end of year (total assets less liabilities)2021-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$569,935
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$569,935
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2021-12-31351387485
2020 : LIFE AD&D DEPENDENT LIFE 2020 401k financial data
Total income from all sources (including contributions)2020-12-31$800,232
Total of all expenses incurred2020-12-31$800,232
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$800,232
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$800,232
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net assets at end of year (total assets less liabilities)2020-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$800,232
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$800,232
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2020-12-31351387485
2019 : LIFE AD&D DEPENDENT LIFE 2019 401k financial data
Total income from all sources (including contributions)2019-12-31$830,646
Total income from all sources (including contributions)2019-12-31$830,646
Total of all expenses incurred2019-12-31$830,646
Total of all expenses incurred2019-12-31$830,646
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$830,646
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$830,646
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$830,646
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$830,646
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net assets at end of year (total assets less liabilities)2019-12-31$0
Value of net assets at end of year (total assets less liabilities)2019-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$830,646
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$830,646
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$830,646
Contributions received in cash from employer2019-12-31$830,646
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm name2019-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2019-12-31351387485
2018 : LIFE AD&D DEPENDENT LIFE 2018 401k financial data
Total income from all sources (including contributions)2018-12-31$1,518,965
Total of all expenses incurred2018-12-31$1,518,965
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,518,965
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,518,965
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net assets at end of year (total assets less liabilities)2018-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$1,518,965
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$1,518,965
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2018-12-31351387485
2017 : LIFE AD&D DEPENDENT LIFE 2017 401k financial data
Total income from all sources (including contributions)2017-12-31$731,256
Total of all expenses incurred2017-12-31$731,256
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$731,256
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$731,256
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net assets at end of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$731,256
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$731,256
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2017-12-31351387485
2016 : LIFE AD&D DEPENDENT LIFE 2016 401k financial data
Total income from all sources (including contributions)2016-12-31$347,363
Total of all expenses incurred2016-12-31$347,363
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$347,363
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$347,363
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net assets at end of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$347,363
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$347,363
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2016-12-31351387485
2015 : LIFE AD&D DEPENDENT LIFE 2015 401k financial data
Total income from all sources (including contributions)2015-12-31$268,375
Total of all expenses incurred2015-12-31$268,375
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$268,375
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$268,375
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net assets at end of year (total assets less liabilities)2015-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$268,375
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$268,375
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2015-12-31351387485
2014 : LIFE AD&D DEPENDENT LIFE 2014 401k financial data
Total income from all sources (including contributions)2014-12-31$244,575
Total of all expenses incurred2014-12-31$244,575
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$244,575
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$244,575
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net assets at end of year (total assets less liabilities)2014-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$244,575
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$244,575
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2014-12-31351387485
2013 : LIFE AD&D DEPENDENT LIFE 2013 401k financial data
Total income from all sources (including contributions)2013-12-31$231,542
Total of all expenses incurred2013-12-31$231,542
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$231,542
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$231,542
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$231,542
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$231,542
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2013-12-31351387485
2012 : LIFE AD&D DEPENDENT LIFE 2012 401k financial data
Total income from all sources (including contributions)2012-12-31$144,782
Total of all expenses incurred2012-12-31$144,782
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$144,782
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$144,782
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net assets at end of year (total assets less liabilities)2012-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$144,782
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$144,782
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2012-12-31351387485
2011 : LIFE AD&D DEPENDENT LIFE 2011 401k financial data
Total income from all sources (including contributions)2011-12-31$126,320
Total of all expenses incurred2011-12-31$126,320
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$126,320
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$126,320
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net assets at end of year (total assets less liabilities)2011-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$126,320
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$126,320
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2011-12-31351387485
2010 : LIFE AD&D DEPENDENT LIFE 2010 401k financial data
Total income from all sources (including contributions)2010-12-31$116,745
Total of all expenses incurred2010-12-31$116,745
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$116,745
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$116,745
Value of total assets at end of year2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net assets at end of year (total assets less liabilities)2010-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$116,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$116,745
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31BUECHLEIN & ASSOCIATES, P.C.
Accountancy firm EIN2010-12-31351387485

Form 5500 Responses for LIFE AD&D DEPENDENT LIFE

2021: LIFE AD&D DEPENDENT LIFE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01This submission is the final filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: LIFE AD&D DEPENDENT LIFE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LIFE AD&D DEPENDENT LIFE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: LIFE AD&D DEPENDENT LIFE 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: LIFE AD&D DEPENDENT LIFE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: LIFE AD&D DEPENDENT LIFE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: LIFE AD&D DEPENDENT LIFE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: LIFE AD&D DEPENDENT LIFE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LIFE AD&D DEPENDENT LIFE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LIFE AD&D DEPENDENT LIFE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LIFE AD&D DEPENDENT LIFE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: LIFE AD&D DEPENDENT LIFE 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number902534
Policy instance 1
Insurance contract or identification number902534
Number of Individuals Covered846
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $135,632
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $569,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $85,101
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit 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
Temporary 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
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number902534
Policy instance 1
Insurance contract or identification number902534
Number of Individuals Covered838
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $143,754
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $656,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143,754
Additional information about fees paid to insurance brokerBROKER
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number902534
Policy instance 1
Insurance contract or identification number902534
Number of Individuals Covered1097
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $137,929
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $692,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $137,929
Additional information about fees paid to insurance brokerBROKER
KENTUCKY HEALTH ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCL160451
Policy instance 2
Insurance contract or identification numberCL160451
Number of Individuals Covered1000
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $28,705
Welfare Benefit Premiums Paid to CarrierUSD $873,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,705
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number902534
Policy instance 1
Insurance contract or identification number902534
Number of Individuals Covered1125
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $106,387
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $645,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $106,387
Additional information about fees paid to insurance brokerBROKER
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00612804
Policy instance 1
Insurance contract or identification numberG 00612804
Number of Individuals Covered949
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $135,349
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $595,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,665
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES LLC
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00612804
Policy instance 1
Insurance contract or identification numberG 00612804
Number of Individuals Covered868
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $53,674
Total amount of fees paid to insurance companyUSD $268,375
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $268,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,674
Amount paid for insurance broker fees268375
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameASSURED NEACE LUEKENS INS
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00612804
Policy instance 1
Insurance contract or identification numberG 00612804
Number of Individuals Covered771
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $48,915
Total amount of fees paid to insurance companyUSD $244,575
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $244,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,915
Amount paid for insurance broker fees244575
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameASSURED NEACE LUEKENS INS
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00612804
Policy instance 2
Insurance contract or identification numberG 00612804
Number of Individuals Covered764
Insurance policy start date2013-09-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16,496
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $82,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,496
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameASSURED NEACE LUEKENS INS
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF007848
Policy instance 1
Insurance contract or identification numberF007848
Number of Individuals Covered760
Insurance policy start date2013-01-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $42,779
Life Insurance Welfare BenefitYes
Other welfare benefits providedACC DEATH & DISM
Welfare Benefit Premiums Paid to CarrierUSD $149,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,951
Additional information about fees paid to insurance brokerBROKER 4
Insurance broker nameASSURED NL INSURANCE AGENCY, INC.
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF007848
Policy instance 1
Insurance contract or identification numberF007848
Number of Individuals Covered555
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $41,511
Life Insurance Welfare BenefitYes
Other welfare benefits providedACC DEATH & DISM
Welfare Benefit Premiums Paid to CarrierUSD $144,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,511
Additional information about fees paid to insurance brokerBROKER 4
Insurance broker nameBROWN & BROWN OF SOUTHWEST IN
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF007848
Policy instance 1
Insurance contract or identification numberF007848
Number of Individuals Covered540
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $36,293
Life Insurance Welfare BenefitYes
Other welfare benefits providedACC DEATH DISM
Welfare Benefit Premiums Paid to CarrierUSD $126,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF007848
Policy instance 1
Insurance contract or identification numberF007848
Number of Individuals Covered629
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $33,481
Total amount of fees paid to insurance companyUSD $1,357
Life Insurance Welfare BenefitYes
Other welfare benefits providedACC DEATH DISM
Welfare Benefit Premiums Paid to CarrierUSD $116,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,481
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?4
Amount paid for insurance broker fees1357
Insurance broker nameBROAN & BROWN OF KENTUCKY

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