401k Plan data: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN plan

VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 401k Plan overview

Plan Name	VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN
Plan identification number	503

VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) 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. LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01 TIM MULLEN 2023-09-18
503 2021-01-01 TIMOTHY F. MULLEN 2022-10-13 TIMOTHY F. MULLEN 2022-10-13
503 2020-01-01 TIMOTHY F. MULLEN 2021-10-15 TIMOTHY F. MULLEN 2021-10-15
503 2019-01-01 TIMOTHY F. MULLEN 2020-10-15 TIMOTHY F. MULLEN 2020-10-15
503 2018-01-01 TIMOTHY F. MULLEN 2019-10-15 TIMOTHY F. MULLEN 2019-10-15
503 2017-01-01
503 2016-01-01
503 2015-01-01
503 2014-01-01
503 2013-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2014-10-14
503 2012-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2013-10-09
503 2011-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2012-10-07
503 2009-01-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2010-10-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2022-01-01	TIM MULLEN	2023-09-18
503	2021-01-01	TIMOTHY F. MULLEN	2022-10-13	TIMOTHY F. MULLEN	2022-10-13
503	2020-01-01	TIMOTHY F. MULLEN	2021-10-15	TIMOTHY F. MULLEN	2021-10-15
503	2019-01-01	TIMOTHY F. MULLEN	2020-10-15	TIMOTHY F. MULLEN	2020-10-15
503	2018-01-01	TIMOTHY F. MULLEN	2019-10-15	TIMOTHY F. MULLEN	2019-10-15
503	2017-01-01
503	2016-01-01
503	2015-01-01
503	2014-01-01
503	2013-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2014-10-14
503	2012-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2013-10-09
503	2011-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2012-10-07
503	2009-01-01	STEVEN J. KRITZMIRE		STEVEN J. KRITZMIRE	2010-10-12

Plan Statistics for VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN

401k plan membership statisitcs for VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN

Measure Date Value
2022: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 132
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 2022-01-01 132
Number of employers contributing to the scheme 2022-01-01 0
2021: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 131
Total of all active and inactive participants 2021-01-01 131
Total participants 2021-01-01 131
2020: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 137
Total of all active and inactive participants 2020-01-01 137
Total participants 2020-01-01 137
2019: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 122
Total of all active and inactive participants 2019-01-01 122
Total participants 2019-01-01 122
2018: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 17
Total of all active and inactive participants 2018-01-01 17
Total participants 2018-01-01 17
2017: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 2017-01-01 136
Total of all active and inactive participants 2017-01-01 136
Total participants 2017-01-01 136
2016: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 132
Total of all active and inactive participants 2016-01-01 132
Total participants 2016-01-01 132
2015: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 134
Total of all active and inactive participants 2015-01-01 134
Total participants 2015-01-01 134
2014: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 107
Total of all active and inactive participants 2014-01-01 107
Total participants 2014-01-01 107
2013: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 76
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 106
Total of all active and inactive participants 2013-01-01 106
Total participants 2013-01-01 106
2012: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 105
Total of all active and inactive participants 2012-01-01 105
Total participants 2012-01-01 105
2011: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 118
Total of all active and inactive participants 2011-01-01 118
Total participants 2011-01-01 118
2009: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 114
Total of all active and inactive participants 2009-01-01 114

Measure	Date	Value
2022: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	132
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	132
Number of employers contributing to the scheme	2022-01-01	0
2021: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	131
Total of all active and inactive participants	2021-01-01	131
Total participants	2021-01-01	131
2020: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	137
Total of all active and inactive participants	2020-01-01	137
Total participants	2020-01-01	137
2019: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	122
Total of all active and inactive participants	2019-01-01	122
Total participants	2019-01-01	122
2018: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	17
Total of all active and inactive participants	2018-01-01	17
Total participants	2018-01-01	17
2017: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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	136
Total of all active and inactive participants	2017-01-01	136
Total participants	2017-01-01	136
2016: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	132
Total of all active and inactive participants	2016-01-01	132
Total participants	2016-01-01	132
2015: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	134
Total of all active and inactive participants	2015-01-01	134
Total participants	2015-01-01	134
2014: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	107
Total of all active and inactive participants	2014-01-01	107
Total participants	2014-01-01	107
2013: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	76
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	106
Total of all active and inactive participants	2013-01-01	106
Total participants	2013-01-01	106
2012: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	105
Total of all active and inactive participants	2012-01-01	105
Total participants	2012-01-01	105
2011: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	118
Total of all active and inactive participants	2011-01-01	118
Total participants	2011-01-01	118
2009: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	114
Total of all active and inactive participants	2009-01-01	114

Form 5500 Responses for VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN

2022: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2021: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2020: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2019: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2018: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2015: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2014: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2013: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2012: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2011: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes
2009: VAN AUSDALL & FARRAR, INC. LIFE INSURANCE PLAN 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	132
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,602
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $60,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,868
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	79
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $877
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $335
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	70
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,220
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,984
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	68
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,456
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,554
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	104
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,530
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,530
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	131
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,547
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,132
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	120
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,576
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,945
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	74
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	66
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,712
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,570
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	63
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,911
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,193
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	63
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	63
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	53
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,086
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,814
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	58
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,689
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,353
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	74
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	123
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,294
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,786
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	68
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	51
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,588
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $90
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	55
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,360
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $155
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756328

Policy instance

Insurance contract or identification number	756328
Number of Individuals Covered	81
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	124
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,226
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $224
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05933488

Policy instance

Insurance contract or identification number	KM05933488
Number of Individuals Covered	305
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,258
Total amount of fees paid to insurance company	USD $1,626
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,258
Amount paid for insurance broker fees	1626
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	57
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,049
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,867
Insurance broker organization code?	3
Insurance broker name	NFP INSURANCE SERVICES INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	65
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,108
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,763
Insurance broker organization code?	3
Insurance broker name	NFP INSURANCE SERVICES INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	136
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,573
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,201
Insurance broker organization code?	3
Insurance broker name	NFP INSURANCE SERVICES INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	134
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,415
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,415
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	96
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,317
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,317
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	61
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,710
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,710
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

158992

Policy instance

Insurance contract or identification number	158992
Number of Individuals Covered	75
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,233
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,233
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D025399

Policy instance

Insurance contract or identification number	00001D025399
Number of Individuals Covered	77
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,374
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,374
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010169151

Policy instance

Insurance contract or identification number	000010169151
Number of Individuals Covered	114
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $915
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $7,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $915
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010169153

Policy instance

Insurance contract or identification number	000010169153
Number of Individuals Covered	73
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,080
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,080
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010169152

Policy instance

Insurance contract or identification number	000010169152
Number of Individuals Covered	64
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,992
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,992
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010169152

Policy instance

Insurance contract or identification number	000010169152
Number of Individuals Covered	55
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,536
Total amount of fees paid to insurance company	USD $233
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,536
Amount paid for insurance broker fees	233
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010169153

Policy instance

Insurance contract or identification number	000010169153
Number of Individuals Covered	66
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,602
Total amount of fees paid to insurance company	USD $410
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,602
Amount paid for insurance broker fees	410
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D025399

Policy instance

Insurance contract or identification number	00001D025399
Number of Individuals Covered	74
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,528
Total amount of fees paid to insurance company	USD $329
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,528
Amount paid for insurance broker fees	329
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010169151

Policy instance

Insurance contract or identification number	000010169151
Number of Individuals Covered	104
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $987
Total amount of fees paid to insurance company	USD $172
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $7,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $987
Amount paid for insurance broker fees	172
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1009787

Policy instance

Insurance contract or identification number	1009787
Number of Individuals Covered	306
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,671
Total amount of fees paid to insurance company	USD $4,066
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,671
Amount paid for insurance broker fees	1563
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	NFP INSURANCE SERVICES INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1009787

Policy instance

Insurance contract or identification number	1009787
Number of Individuals Covered	178
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,773
Total amount of fees paid to insurance company	USD $1,134
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $135,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1009787

Policy instance

Insurance contract or identification number	1009787
Number of Individuals Covered	107
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,571
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,571
Insurance broker organization code?	3
Insurance broker name	SHEPHERD INSURANCE AGENCY INC

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