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R P ENTERPRISES RETIREMENT PLAN 401k Plan overview

Plan NameR P ENTERPRISES RETIREMENT PLAN
Plan identification number 001

R P ENTERPRISES RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

R P ENTERPRISES, INC. has sponsored the creation of one or more 401k plans.

Company Name:R P ENTERPRISES, INC.
Employer identification number (EIN):383831919
NAIC Classification:722513
NAIC Description:Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan R P ENTERPRISES RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012018-01-01RYAN PAGE
0012017-01-01RYAN PAGE
0012016-01-01RYAN PAGE RYAN PAGE2017-08-17
0012015-01-01RYAN PAGE RYAN PAGE2016-09-22
0012014-01-01RYAN PAGE RYAN PAGE2015-06-16
0012013-01-01RYAN PAGE RYAN PAGE2014-07-09
0012012-01-01RYAN PAGE RYAN PAGE2013-03-20
0012011-02-07RYAN PAGE RYAN PAGE2012-03-15

Plan Statistics for R P ENTERPRISES RETIREMENT PLAN

401k plan membership statisitcs for R P ENTERPRISES RETIREMENT PLAN

Measure Date Value
2018: R P ENTERPRISES RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-015
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-010
Number of participants with account balances2018-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: R P ENTERPRISES RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-016
Total number of active participants reported on line 7a of the Form 55002017-01-014
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-011
Total of all active and inactive participants2017-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-015
Number of participants with account balances2017-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: R P ENTERPRISES RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-018
Total number of active participants reported on line 7a of the Form 55002016-01-016
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-016
Number of participants with account balances2016-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: R P ENTERPRISES RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-014
Total number of active participants reported on line 7a of the Form 55002015-01-015
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-013
Total of all active and inactive participants2015-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-018
Number of participants with account balances2015-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: R P ENTERPRISES RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-018
Total number of active participants reported on line 7a of the Form 55002014-01-013
Number of other retired or separated participants entitled to future benefits2014-01-014
Total of all active and inactive participants2014-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-017
Number of participants with account balances2014-01-017
2013: R P ENTERPRISES RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-014
Total number of active participants reported on line 7a of the Form 55002013-01-014
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-014
Number of participants with account balances2013-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: R P ENTERPRISES RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011
Total number of active participants reported on line 7a of the Form 55002012-01-011
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-011
Number of participants with account balances2012-01-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: R P ENTERPRISES RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-071
Total number of active participants reported on line 7a of the Form 55002011-02-071
Number of retired or separated participants receiving benefits2011-02-070
Number of other retired or separated participants entitled to future benefits2011-02-070
Total of all active and inactive participants2011-02-071
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-02-070
Total participants2011-02-071
Number of participants with account balances2011-02-071
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-02-070

Financial Data on R P ENTERPRISES RETIREMENT PLAN

Measure Date Value
2018 : R P ENTERPRISES RETIREMENT PLAN 2018 401k financial data
Total income from all sources2018-04-24$119,091
Expenses. Total of all expenses incurred2018-04-24$296,267
Benefits paid (including direct rollovers)2018-04-24$296,267
Total plan assets at end of year2018-04-24$0
Total plan assets at beginning of year2018-04-24$177,176
Value of fidelity bond covering the plan2018-04-24$250,000
Other income received2018-04-24$119,091
Net income (gross income less expenses)2018-04-24$-177,176
Net plan assets at end of year (total assets less liabilities)2018-04-24$0
Net plan assets at beginning of year (total assets less liabilities)2018-04-24$177,176
Assets. Value of employer securities2018-04-24$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-04-24$0
2017 : R P ENTERPRISES RETIREMENT PLAN 2017 401k financial data
Total plan liabilities at beginning of year2017-12-31$8,220
Total income from all sources2017-12-31$109,216
Expenses. Total of all expenses incurred2017-12-31$0
Total plan assets at end of year2017-12-31$177,176
Total plan assets at beginning of year2017-12-31$76,180
Value of fidelity bond covering the plan2017-12-31$250,000
Total contributions received or receivable from participants2017-12-31$1,707
Other income received2017-12-31$106,249
Net income (gross income less expenses)2017-12-31$109,216
Net plan assets at end of year (total assets less liabilities)2017-12-31$177,176
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$67,960
Assets. Value of employer securities2017-12-31$135,612
Total contributions received or receivable from employer(s)2017-12-31$1,260
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : R P ENTERPRISES RETIREMENT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$8,220
Total plan liabilities at beginning of year2016-12-31$8,220
Total income from all sources2016-12-31$-384,311
Expenses. Total of all expenses incurred2016-12-31$3,640
Benefits paid (including direct rollovers)2016-12-31$3,475
Total plan assets at end of year2016-12-31$76,180
Total plan assets at beginning of year2016-12-31$464,131
Value of fidelity bond covering the plan2016-12-31$250,000
Total contributions received or receivable from participants2016-12-31$1,175
Other income received2016-12-31$-385,956
Net income (gross income less expenses)2016-12-31$-387,951
Net plan assets at end of year (total assets less liabilities)2016-12-31$67,960
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$455,911
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022016-12-31$320
Assets. Value of employer securities2016-12-31$35,000
Total contributions received or receivable from employer(s)2016-12-31$470
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$165
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : R P ENTERPRISES RETIREMENT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$8,220
Total plan liabilities at beginning of year2015-12-31$8,220
Total income from all sources2015-12-31$14,298
Expenses. Total of all expenses incurred2015-12-31$0
Total plan assets at end of year2015-12-31$464,131
Total plan assets at beginning of year2015-12-31$449,833
Value of fidelity bond covering the plan2015-12-31$50,000
Total contributions received or receivable from participants2015-12-31$7,215
Other income received2015-12-31$4,861
Net income (gross income less expenses)2015-12-31$14,298
Net plan assets at end of year (total assets less liabilities)2015-12-31$455,911
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$441,613
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022015-12-31$320
Assets. Value of employer securities2015-12-31$423,243
Total contributions received or receivable from employer(s)2015-12-31$2,222
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : R P ENTERPRISES RETIREMENT PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$8,220
Total income from all sources2014-12-31$27,488
Expenses. Total of all expenses incurred2014-12-31$127
Total plan assets at end of year2014-12-31$449,833
Total plan assets at beginning of year2014-12-31$414,252
Value of fidelity bond covering the plan2014-12-31$50,000
Total contributions received or receivable from participants2014-12-31$7,667
Expenses. Other expenses not covered elsewhere2014-12-31$127
Other income received2014-12-31$16,529
Net income (gross income less expenses)2014-12-31$27,361
Net plan assets at end of year (total assets less liabilities)2014-12-31$441,613
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$414,252
Assets. Value of employer securities2014-12-31$417,374
Total contributions received or receivable from employer(s)2014-12-31$3,292
2013 : R P ENTERPRISES RETIREMENT PLAN 2013 401k financial data
Total income from all sources2013-12-31$26,477
Expenses. Total of all expenses incurred2013-12-31$0
Total plan assets at end of year2013-12-31$414,252
Total plan assets at beginning of year2013-12-31$387,775
Value of fidelity bond covering the plan2013-12-31$50,000
Total contributions received or receivable from participants2013-12-31$5,354
Other income received2013-12-31$19,113
Net income (gross income less expenses)2013-12-31$26,477
Net plan assets at end of year (total assets less liabilities)2013-12-31$414,252
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$387,775
Assets. Value of employer securities2013-12-31$401,371
Total contributions received or receivable from employer(s)2013-12-31$2,010
2012 : R P ENTERPRISES RETIREMENT PLAN 2012 401k financial data
Total income from all sources2012-12-31$46,240
Expenses. Total of all expenses incurred2012-12-31$0
Total plan assets at end of year2012-12-31$387,775
Total plan assets at beginning of year2012-12-31$341,535
Other income received2012-12-31$46,240
Net income (gross income less expenses)2012-12-31$46,240
Net plan assets at end of year (total assets less liabilities)2012-12-31$387,775
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$341,535
Assets. Value of employer securities2012-12-31$382,735
2011 : R P ENTERPRISES RETIREMENT PLAN 2011 401k financial data
Total income from all sources2011-12-31$341,537
Expenses. Total of all expenses incurred2011-12-31$2
Total plan assets at end of year2011-12-31$341,535
Expenses. Other expenses not covered elsewhere2011-12-31$2
Contributions received from other sources (not participants or employers)2011-12-31$325,000
Other income received2011-12-31$16,537
Net income (gross income less expenses)2011-12-31$341,535
Net plan assets at end of year (total assets less liabilities)2011-12-31$341,535
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$0
Assets. Value of employer securities2011-12-31$336,500

Form 5500 Responses for R P ENTERPRISES RETIREMENT PLAN

2018: R P ENTERPRISES RETIREMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingYes
2018-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: R P ENTERPRISES RETIREMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: R P ENTERPRISES RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: R P ENTERPRISES RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: R P ENTERPRISES RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: R P ENTERPRISES RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: R P ENTERPRISES RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: R P ENTERPRISES RETIREMENT PLAN 2011 form 5500 responses
2011-02-07Type of plan entitySingle employer plan
2011-02-07First time form 5500 has been submittedYes
2011-02-07Submission has been amendedYes
2011-02-07This submission is the final filingNo
2011-02-07This return/report is a short plan year return/report (less than 12 months)Yes
2011-02-07Plan is a collectively bargained planNo
2011-02-07Plan funding arrangement – TrustYes
2011-02-07Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number915657-01
Policy instance 1
Insurance contract or identification number915657-01
Number of Individuals Covered0
Insurance policy start date2018-01-01
Insurance policy end date2018-01-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number915657-01
Policy instance 1
Insurance contract or identification number915657-01
Number of Individuals Covered4
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number915657-01
Policy instance 1
Insurance contract or identification number915657-01
Number of Individuals Covered7
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number915657-01
Policy instance 1
Insurance contract or identification number915657-01
Number of Individuals Covered7
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number915657-01
Policy instance 1
Insurance contract or identification number915657-01
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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