OZINGA BROS., INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN
401k plan membership statisitcs for OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2022: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 713 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 736 |
| Total of all active and inactive participants | 2022-01-01 | 736 |
| 2021: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 682 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 713 |
| Total of all active and inactive participants | 2021-01-01 | 713 |
| 2020: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 681 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 682 |
| Total of all active and inactive participants | 2020-01-01 | 682 |
| 2019: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 613 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 681 |
| Total of all active and inactive participants | 2019-01-01 | 681 |
| 2018: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 507 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 613 |
| Total of all active and inactive participants | 2018-01-01 | 613 |
| 2017: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 398 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 507 |
| Total of all active and inactive participants | 2017-01-01 | 507 |
| 2016: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 359 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 398 |
| Total of all active and inactive participants | 2016-01-01 | 398 |
| 2015: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 297 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 359 |
| Total of all active and inactive participants | 2015-01-01 | 359 |
| 2014: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 208 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 297 |
| Total of all active and inactive participants | 2014-01-01 | 297 |
| 2013: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 208 |
| Total of all active and inactive participants | 2013-01-01 | 208 |
| 2012: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 160 |
| Total of all active and inactive participants | 2012-01-01 | 160 |
| 2011: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 146 |
| Total of all active and inactive participants | 2011-01-01 | 146 |
| 2010: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 139 |
| Total of all active and inactive participants | 2010-01-01 | 139 |
| 2009: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 150 |
| Total of all active and inactive participants | 2009-01-01 | 150 |
| 2022: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS 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 |
| 2010: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 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 benefit arrangement – Insurance | Yes |
| 2009: OZINGA BROS., INC. GROUP LIFE, AD&D AND LONG TERM DISABILITY BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 921123 |
| Policy instance | 1 |
| Insurance contract or identification number | 921123 | | Number of Individuals Covered | 736 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $46,883 | | 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 $472,299 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,957 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 921123 |
| Policy instance | 1 |
| Insurance contract or identification number | 921123 | | Number of Individuals Covered | 713 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $45,193 | | 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 $437,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,193 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60236 |
| Policy instance | 1 |
| Insurance contract or identification number | 60236 | | Number of Individuals Covered | 683 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $26,512 | | Total amount of fees paid to insurance company | USD $163 | | 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 $265,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,512 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 142 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60236 |
| Policy instance | 1 |
| Insurance contract or identification number | 60236 | | Number of Individuals Covered | 681 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $21,170 | | Total amount of fees paid to insurance company | USD $230 | | 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 $211,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,170 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 230 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60236 |
| Policy instance | 1 |
| Insurance contract or identification number | 60236 | | Number of Individuals Covered | 613 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $21,899 | | Total amount of fees paid to insurance company | USD $203 | | 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 $186,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,899 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 203 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 60236 |
| Policy instance | 4 |
| Insurance contract or identification number | 60236 | | Number of Individuals Covered | 507 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,179 | | Total amount of fees paid to insurance company | USD $87 | | 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 $91,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,179 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 87 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker name | AXA ASSISTANCE USA |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 607379 |
| Policy instance | 3 |
| Insurance contract or identification number | 607379 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-07-01 | | Total amount of commissions paid to insurance broker | USD $18,344 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $120,959 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,344 | | Insurance broker organization code? | 3 | | Insurance broker name | THE VAN DYKE GROUP |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 605655 |
| Policy instance | 2 |
| Insurance contract or identification number | 605655 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $9,211 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,211 | | Insurance broker organization code? | 3 | | Insurance broker name | THE VAN DYKE GROUP |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 405418 |
| Policy instance | 1 |
| Insurance contract or identification number | 405418 | | Number of Individuals Covered | 424 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2017-06-01 | | Total amount of commissions paid to insurance broker | USD $124 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $124 | | Insurance broker organization code? | 3 | | Insurance broker name | THE VAN DYKE GROUP |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 405418 |
| Policy instance | 1 |
| Insurance contract or identification number | 405418 | | Number of Individuals Covered | 365 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-05-01 | | Total amount of commissions paid to insurance broker | USD $8,440 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $126,935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,440 | | Insurance broker name | THE VAN DYKE GROUP |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000405418 |
| Policy instance | 1 |
| Insurance contract or identification number | 000000405418 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-05-01 | | Total amount of commissions paid to insurance broker | USD $9,391 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $102,701 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,391 | | Insurance broker name | THE VAN DYKE GROUP |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL144446 |
| Policy instance | 1 |
| Insurance contract or identification number | GL144446 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,512 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,512 | | Insurance broker name | THE VAN DYKE GROUP |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL144446 |
| Policy instance | 1 |
| Insurance contract or identification number | GL144446 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,097 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,097 | | Insurance broker name | THE VAN DYKE GROUP |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL144446 |
| Policy instance | 1 |
| Insurance contract or identification number | GL144446 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $2,258 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL144446 |
| Policy instance | 1 |
| Insurance contract or identification number | GL144446 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $1,917 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,342 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,917 | | Insurance broker organization code? | 3 | | Insurance broker name | THE VAN DYKE GROUP INC |
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