401k Plan data: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST plan

VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 401k Plan overview

Plan Name	VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST
Plan identification number	501

VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Other welfare benefit cover

401k Sponsoring company profile

VAN AUSDALL & FARRAR, INC. has sponsored the creation of one or more 401k plans.

Company Name: VAN AUSDALL & FARRAR, INC.

Employer identification number (EIN): 351067666

NAIC Classification: 454390
NAIC Description: Other Direct Selling Establishments

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 TIM MULLEN 2023-09-25
501 2021-01-01 TIMOTHY F MULLEN 2022-10-11 TIMOTHY F MULLEN 2022-10-11
501 2020-01-01 TIMOTHY F. MULLEN 2021-10-12 TIMOTHY F. MULLEN 2021-10-12
501 2019-01-01 TIMOTHY F. MULLEN 2020-10-13 TIMOTHY F. MULLEN 2020-10-13
501 2018-01-01 TIMOTHY F. MULLEN 2019-10-25 TIMOTHY F. MULLEN 2019-10-25
501 2018-01-01 TIMOTHY F. MULLEN 2019-10-14 TIMOTHY F. MULLEN 2019-10-14
501 2017-01-01
501 2017-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2014-10-14
501 2012-01-01 STEVEN J. KRITMIRE STEVEN J. KRITMIRE 2013-10-09
501 2011-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2012-10-07
501 2010-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2011-10-14
501 2009-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	TIM MULLEN	2023-09-25
501	2021-01-01	TIMOTHY F MULLEN	2022-10-11	TIMOTHY F MULLEN	2022-10-11
501	2020-01-01	TIMOTHY F. MULLEN	2021-10-12	TIMOTHY F. MULLEN	2021-10-12
501	2019-01-01	TIMOTHY F. MULLEN	2020-10-13	TIMOTHY F. MULLEN	2020-10-13
501	2018-01-01	TIMOTHY F. MULLEN	2019-10-25	TIMOTHY F. MULLEN	2019-10-25
501	2018-01-01	TIMOTHY F. MULLEN	2019-10-14	TIMOTHY F. MULLEN	2019-10-14
501	2017-01-01
501	2017-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2014-10-14
501	2012-01-01	STEVEN J. KRITMIRE		STEVEN J. KRITMIRE	2013-10-09
501	2011-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2012-10-07
501	2010-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2011-10-14
501	2009-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2010-10-14

Plan Statistics for VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST

401k plan membership statisitcs for VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST

Measure Date Value
2022: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2022 401k membership
Total participants, beginning-of-year 2022-01-01 95
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 92
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 92
Number of employers contributing to the scheme 2022-01-01 0
2021: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2021 401k membership
Total participants, beginning-of-year 2021-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 92
Number of retired or separated participants receiving benefits 2021-01-01 3
Total of all active and inactive participants 2021-01-01 95
Total participants 2021-01-01 95
2020: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2020 401k membership
Total participants, beginning-of-year 2020-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 79
Number of retired or separated participants receiving benefits 2020-01-01 3
Total of all active and inactive participants 2020-01-01 82
Total participants 2020-01-01 82
2019: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2019 401k membership
Total participants, beginning-of-year 2019-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 92
Number of retired or separated participants receiving benefits 2019-01-01 1
Total of all active and inactive participants 2019-01-01 93
Total participants 2019-01-01 93
2018: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2018 401k membership
Total participants, beginning-of-year 2018-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 97
Number of retired or separated participants receiving benefits 2018-01-01 1
Total of all active and inactive participants 2018-01-01 98
Total participants 2018-01-01 98
2017: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2017 401k membership
Total participants, beginning-of-year 2017-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 197
Total of all active and inactive participants 2017-01-01 197
Total participants 2017-01-01 197
2016: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 101
Number of retired or separated participants receiving benefits 2016-01-01 2
Total of all active and inactive participants 2016-01-01 103
Total participants 2016-01-01 103
2015: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 81
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 97
Number of retired or separated participants receiving benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 100
Total participants 2015-01-01 100
2014: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 83
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 81
Number of retired or separated participants receiving benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 82
Total participants 2014-01-01 82
2013: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 82
Number of retired or separated participants receiving benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 84
Total participants 2013-01-01 84
2012: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 79
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 83
Number of retired or separated participants receiving benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 85
Total participants 2012-01-01 85
2011: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 82
Total of all active and inactive participants 2011-01-01 82
Total participants 2011-01-01 82
2010: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 83
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 89
Number of retired or separated participants receiving benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 90
Total participants 2010-01-01 90
2009: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 85
Number of retired or separated participants receiving benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 88
Total participants 2009-01-01 88

Measure	Date	Value
2022: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2022 401k membership
Total participants, beginning-of-year	2022-01-01	95
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	92
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	92
Number of employers contributing to the scheme	2022-01-01	0
2021: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2021 401k membership
Total participants, beginning-of-year	2021-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	92
Number of retired or separated participants receiving benefits	2021-01-01	3
Total of all active and inactive participants	2021-01-01	95
Total participants	2021-01-01	95
2020: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2020 401k membership
Total participants, beginning-of-year	2020-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	79
Number of retired or separated participants receiving benefits	2020-01-01	3
Total of all active and inactive participants	2020-01-01	82
Total participants	2020-01-01	82
2019: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	92
Number of retired or separated participants receiving benefits	2019-01-01	1
Total of all active and inactive participants	2019-01-01	93
Total participants	2019-01-01	93
2018: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	97
Number of retired or separated participants receiving benefits	2018-01-01	1
Total of all active and inactive participants	2018-01-01	98
Total participants	2018-01-01	98
2017: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	197
Total of all active and inactive participants	2017-01-01	197
Total participants	2017-01-01	197
2016: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	101
Number of retired or separated participants receiving benefits	2016-01-01	2
Total of all active and inactive participants	2016-01-01	103
Total participants	2016-01-01	103
2015: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	81
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	97
Number of retired or separated participants receiving benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	100
Total participants	2015-01-01	100
2014: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	83
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	81
Number of retired or separated participants receiving benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	82
Total participants	2014-01-01	82
2013: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	82
Number of retired or separated participants receiving benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	84
Total participants	2013-01-01	84
2012: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	79
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	83
Number of retired or separated participants receiving benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	85
Total participants	2012-01-01	85
2011: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	82
Total of all active and inactive participants	2011-01-01	82
Total participants	2011-01-01	82
2010: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	83
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	89
Number of retired or separated participants receiving benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	90
Total participants	2010-01-01	90
2009: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	85
Number of retired or separated participants receiving benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	88
Total participants	2009-01-01	88

Financial Data on VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST

Measure	Date	Value
2022 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$890,500
Total of all expenses incurred	2022-12-31	$889,562
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$870,812
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$890,500
Value of total assets at end of year	2022-12-31	$1,938
Value of total assets at beginning of year	2022-12-31	$1,000
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$18,750
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$269,113
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$0
Other income not declared elsewhere	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$1,938
Total non interest bearing cash at beginning of year	2022-12-31	$1,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$938
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$1,938
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,000
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$288,245
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$621,387
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$582,567
Contract administrator fees	2022-12-31	$18,750
Did the plan have assets held for investment	2022-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	FORVIS, LLP
Accountancy firm EIN	2022-12-31	440160260
2021 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$847,442
Total of all expenses incurred	2021-12-31	$853,014
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$836,639
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$762,740
Value of total assets at end of year	2021-12-31	$1,000
Value of total assets at beginning of year	2021-12-31	$6,572
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$16,375
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$311,040
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$8,370
Other income not declared elsewhere	2021-12-31	$84,702
Total non interest bearing cash at end of year	2021-12-31	$1,000
Total non interest bearing cash at beginning of year	2021-12-31	$6,572
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-5,572
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,000
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$6,572
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$346,483
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$443,330
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$490,156
Contract administrator fees	2021-12-31	$16,375
Did the plan have assets held for investment	2021-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	FORVIS, LLP
Accountancy firm EIN	2021-12-31	440160260
2020 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$774,447
Total of all expenses incurred	2020-12-31	$769,951
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$755,450
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$767,338
Value of total assets at end of year	2020-12-31	$6,572
Value of total assets at beginning of year	2020-12-31	$2,076
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$14,501
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$346,388
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$8,338
Other income not declared elsewhere	2020-12-31	$7,109
Total non interest bearing cash at end of year	2020-12-31	$6,572
Total non interest bearing cash at beginning of year	2020-12-31	$2,076
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$4,496
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$6,572
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,076
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$296,735
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$412,612
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$458,715
Contract administrator fees	2020-12-31	$14,501
Did the plan have assets held for investment	2020-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	BKD, LLP
Accountancy firm EIN	2020-12-31	440160260
2019 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$950,550
Total income from all sources (including contributions)	2019-12-31	$950,550
Total of all expenses incurred	2019-12-31	$958,330
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$947,062
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$947,062
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$937,823
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$937,823
Value of total assets at end of year	2019-12-31	$2,076
Value of total assets at end of year	2019-12-31	$2,076
Value of total assets at beginning of year	2019-12-31	$9,856
Value of total assets at beginning of year	2019-12-31	$9,856
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$11,268
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$11,268
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$376,051
Contributions received from participants	2019-12-31	$376,051
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$10,992
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$10,992
Other income not declared elsewhere	2019-12-31	$12,727
Other income not declared elsewhere	2019-12-31	$12,727
Total non interest bearing cash at end of year	2019-12-31	$2,076
Total non interest bearing cash at end of year	2019-12-31	$2,076
Total non interest bearing cash at beginning of year	2019-12-31	$9,856
Total non interest bearing cash at beginning of year	2019-12-31	$9,856
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$-7,780
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,076
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,076
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$9,856
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$9,856
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$307,855
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$307,855
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$550,780
Contributions received in cash from employer	2019-12-31	$550,780
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$639,207
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$639,207
Contract administrator fees	2019-12-31	$11,268
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	BKD, LLP
Accountancy firm EIN	2019-12-31	440160260
Accountancy firm EIN	2019-12-31	440160260
2018 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$1,188,774
Total of all expenses incurred	2018-12-31	$1,180,647
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,149,472
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,178,576
Value of total assets at end of year	2018-12-31	$9,856
Value of total assets at beginning of year	2018-12-31	$1,729
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$31,175
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$451,912
Other income not declared elsewhere	2018-12-31	$10,198
Total non interest bearing cash at end of year	2018-12-31	$9,856
Total non interest bearing cash at beginning of year	2018-12-31	$1,729
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$8,127
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$9,856
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,729
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$377,644
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$726,664
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$771,828
Contract administrator fees	2018-12-31	$31,175
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	BKD, LLP
Accountancy firm EIN	2018-12-31	440160260
2017 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$1,265,706
Total of all expenses incurred	2017-12-31	$1,266,672
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,204,354
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,014,855
Value of total assets at end of year	2017-12-31	$1,729
Value of total assets at beginning of year	2017-12-31	$2,695
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$62,318
Total income from all sources	2017-12-31	$1,265,706
Expenses. Total of all expenses incurred	2017-12-31	$1,266,672
Benefits paid (including direct rollovers)	2017-12-31	$1,204,354
Total plan assets at end of year	2017-12-31	$1,729
Total plan assets at beginning of year	2017-12-31	$2,695
Value of fidelity bond covering the plan	2017-12-31	$500,000
Total contributions received or receivable from participants	2017-12-31	$427,222
Other income received	2017-12-31	$250,851
Net income (gross income less expenses)	2017-12-31	$-966
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,729
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$2,695
Total contributions received or receivable from employer(s)	2017-12-31	$587,633
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$62,318
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$20,453
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$427,222
Other income not declared elsewhere	2017-12-31	$250,851
Administrative expenses (other) incurred	2017-12-31	$2,304
Total non interest bearing cash at end of year	2017-12-31	$1,729
Total non interest bearing cash at beginning of year	2017-12-31	$2,695
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$-966
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,729
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,695
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$277,505
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$587,633
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$926,849
Contract administrator fees	2017-12-31	$39,561
Did the plan have assets held for investment	2017-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	BKD, LLP
Accountancy firm EIN	2017-12-31	440160260
2016 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2016 401k financial data
Total income from all sources	2016-12-31	$1,579,251
Expenses. Total of all expenses incurred	2016-12-31	$1,608,552
Benefits paid (including direct rollovers)	2016-12-31	$1,541,345
Total plan assets at end of year	2016-12-31	$2,695
Total plan assets at beginning of year	2016-12-31	$31,996
Value of fidelity bond covering the plan	2016-12-31	$500,000
Total contributions received or receivable from participants	2016-12-31	$412,420
Other income received	2016-12-31	$301,146
Net income (gross income less expenses)	2016-12-31	$-29,301
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,695
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$31,996
Total contributions received or receivable from employer(s)	2016-12-31	$865,685
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$67,207
2015 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2015 401k financial data
Total income from all sources	2015-12-31	$1,648,148
Expenses. Total of all expenses incurred	2015-12-31	$1,629,019
Benefits paid (including direct rollovers)	2015-12-31	$1,566,337
Total plan assets at end of year	2015-12-31	$31,996
Total plan assets at beginning of year	2015-12-31	$12,867
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$388,905
Other income received	2015-12-31	$669,534
Net income (gross income less expenses)	2015-12-31	$19,129
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$31,996
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$12,867
Total contributions received or receivable from employer(s)	2015-12-31	$589,709
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$62,682
2014 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2014 401k financial data
Total income from all sources	2014-12-31	$696,527
Expenses. Total of all expenses incurred	2014-12-31	$685,290
Benefits paid (including direct rollovers)	2014-12-31	$625,760
Total plan assets at end of year	2014-12-31	$12,867
Total plan assets at beginning of year	2014-12-31	$1,630
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$345,279
Other income received	2014-12-31	$118,472
Net income (gross income less expenses)	2014-12-31	$11,237
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$12,867
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,630
Total contributions received or receivable from employer(s)	2014-12-31	$232,776
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$59,530
2013 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2013 401k financial data
Total income from all sources	2013-12-31	$923,478
Expenses. Total of all expenses incurred	2013-12-31	$946,455
Benefits paid (including direct rollovers)	2013-12-31	$885,167
Total plan assets at end of year	2013-12-31	$1,630
Total plan assets at beginning of year	2013-12-31	$24,607
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$354,679
Other income received	2013-12-31	$202,747
Net income (gross income less expenses)	2013-12-31	$-22,977
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,630
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$24,607
Total contributions received or receivable from employer(s)	2013-12-31	$366,052
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$61,288
2012 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2012 401k financial data
Total income from all sources	2012-12-31	$1,074,093
Expenses. Total of all expenses incurred	2012-12-31	$1,055,651
Benefits paid (including direct rollovers)	2012-12-31	$995,243
Total plan assets at end of year	2012-12-31	$24,607
Total plan assets at beginning of year	2012-12-31	$6,165
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$598,418
Other income received	2012-12-31	$125,785
Net income (gross income less expenses)	2012-12-31	$18,442
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$24,607
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$6,165
Total contributions received or receivable from employer(s)	2012-12-31	$349,890
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$60,408
2011 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2011 401k financial data
Total income from all sources	2011-12-31	$1,626,708
Expenses. Total of all expenses incurred	2011-12-31	$1,623,154
Benefits paid (including direct rollovers)	2011-12-31	$1,564,914
Total plan assets at end of year	2011-12-31	$6,165
Total plan assets at beginning of year	2011-12-31	$2,611
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$641,457
Other income received	2011-12-31	$2,404
Net income (gross income less expenses)	2011-12-31	$3,554
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$6,165
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,611
Total contributions received or receivable from employer(s)	2011-12-31	$982,847
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$58,240
2010 : VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2010 401k financial data
Total income from all sources	2010-12-31	$1,199,388
Expenses. Total of all expenses incurred	2010-12-31	$1,196,912
Benefits paid (including direct rollovers)	2010-12-31	$1,148,135
Total plan assets at end of year	2010-12-31	$2,611
Total plan assets at beginning of year	2010-12-31	$135
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$516,605
Expenses. Other expenses not covered elsewhere	2010-12-31	$11,975
Net income (gross income less expenses)	2010-12-31	$2,476
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,611
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$135
Total contributions received or receivable from employer(s)	2010-12-31	$682,783
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$36,802

Form 5500 Responses for VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST

2022: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: VAN AUSDALL & FARRAR, INC. EMPLOYEE BENEFIT TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

IISI 3632

Policy instance

Insurance contract or identification number	IISI 3632
Number of Individuals Covered	92
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $233,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

100000801012019

Policy instance

Insurance contract or identification number	100000801012019
Number of Individuals Covered	92
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Welfare Benefit Premiums Paid to Carrier	USD $346,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

100000801012019

Policy instance

Insurance contract or identification number	100000801012019
Number of Individuals Covered	82
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Welfare Benefit Premiums Paid to Carrier	USD $296,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

100000801012019

Policy instance

Insurance contract or identification number	100000801012019
Number of Individuals Covered	93
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Welfare Benefit Premiums Paid to Carrier	USD $307,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

417003413318

Policy instance

Insurance contract or identification number	417003413318
Number of Individuals Covered	97
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,024
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $13,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,024
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

417003413318

Policy instance

Insurance contract or identification number	417003413318
Number of Individuals Covered	97
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $43,339
Welfare Benefit Premiums Paid to Carrier	USD $364,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,339
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

TPL-UGU-1018

Policy instance

Insurance contract or identification number	TPL-UGU-1018
Number of Individuals Covered	102
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $35,975
Welfare Benefit Premiums Paid to Carrier	USD $277,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,750
Insurance broker organization code?	3
Insurance broker name	BAS

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

949-5653

Policy instance

Insurance contract or identification number	949-5653
Number of Individuals Covered	99
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,939
Other welfare benefits provided	ORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $19,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,745
Insurance broker organization code?	3
Insurance broker name	BAS

AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )

Policy contract number

ANT2493

Policy instance

Insurance contract or identification number	ANT2493
Number of Individuals Covered	99
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,277
Welfare Benefit Premiums Paid to Carrier	USD $166,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,615
Insurance broker organization code?	3
Insurance broker name	BAS

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

949-5653

Policy instance

Insurance contract or identification number	949-5653
Number of Individuals Covered	85
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,752
Other welfare benefits provided	ORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $17,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,577
Insurance broker organization code?	3
Insurance broker name	BAS

AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 )

Policy contract number

ANT 2069

Policy instance

Insurance contract or identification number	ANT 2069
Number of Individuals Covered	84
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $17,804
Welfare Benefit Premiums Paid to Carrier	USD $136,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,696
Insurance broker organization code?	3
Insurance broker name	BAS

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

949-5653

Policy instance

Insurance contract or identification number	949-5653
Number of Individuals Covered	81
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,294
Other welfare benefits provided	ORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $12,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,165
Insurance broker organization code?	3
Insurance broker name	BAS

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

402814-D

Policy instance

Insurance contract or identification number	402814-D
Number of Individuals Covered	80
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,393
Welfare Benefit Premiums Paid to Carrier	USD $141,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,148
Insurance broker organization code?	3
Insurance broker name	BAS

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

402814-A

Policy instance

Insurance contract or identification number	402814-A
Number of Individuals Covered	144
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $30,996
Welfare Benefit Premiums Paid to Carrier	USD $224,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,843
Insurance broker organization code?	3
Insurance broker name	BAS

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

949-5653

Policy instance

Insurance contract or identification number	949-5653
Number of Individuals Covered	153
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,979
Other welfare benefits provided	ORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $19,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,781
Insurance broker organization code?	3
Insurance broker name	BAS

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

280-8897

Policy instance

Insurance contract or identification number	280-8897
Number of Individuals Covered	161
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,933
Other welfare benefits provided	ORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $19,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

402814-A

Policy instance

Insurance contract or identification number	402814-A
Number of Individuals Covered	173
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $31,231
Welfare Benefit Premiums Paid to Carrier	USD $240,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

402814-A

Policy instance

Insurance contract or identification number	402814-A
Number of Individuals Covered	159
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $25,499
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $196,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,615
Insurance broker organization code?	3
Insurance broker name	BAS

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

ODT 3756868

Policy instance

Insurance contract or identification number	ODT 3756868
Number of Individuals Covered	155
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $10,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

VAN AUSDALL 401K PLAN [EIN = 453996240]

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Company Name:	VAN AUSDALL & FARRAR, INC.
Employer identification number (EIN):	351067666
NAIC Classification:	454390
NAIC Description:	Other Direct Selling Establishments