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SHAWANO MEDICAL CENTER 403(B) PLAN 401k Plan overview

Plan NameSHAWANO MEDICAL CENTER 403(B) PLAN
Plan identification number 007

SHAWANO MEDICAL CENTER 403(B) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.

401k Sponsoring company profile

THEDACARE has sponsored the creation of one or more 401k plans.

Company Name:THEDACARE
Employer identification number (EIN):391509362
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHAWANO MEDICAL CENTER 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0072016-07-01KAREN GARVEY2017-07-24
0072015-07-01KAREN GARVEY2017-01-19
0072014-07-01KAREN GARVEY2016-01-18
0072013-07-01KAREN GARVEY
0072012-07-01KAREN GARVEY
0072011-07-01KAREN GARVEY KAREN GARVEY2013-03-08
0072010-07-01SUSAN FREDERICKSON SUSAN FREDERICKSON2012-04-09

Plan Statistics for SHAWANO MEDICAL CENTER 403(B) PLAN

401k plan membership statisitcs for SHAWANO MEDICAL CENTER 403(B) PLAN

Measure Date Value
2013: SHAWANO MEDICAL CENTER 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01292
Total number of active participants reported on line 7a of the Form 55002013-07-0129
Number of other retired or separated participants entitled to future benefits2013-07-0133
Total of all active and inactive participants2013-07-0162
Total participants2013-07-0162
Number of participants with account balances2013-07-0162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-010
2012: SHAWANO MEDICAL CENTER 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01307
Total number of active participants reported on line 7a of the Form 55002012-07-01239
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-0153
Total of all active and inactive participants2012-07-01292
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-01292
Number of participants with account balances2012-07-01292
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-010
2011: SHAWANO MEDICAL CENTER 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01457
Total number of active participants reported on line 7a of the Form 55002011-07-01383
Number of retired or separated participants receiving benefits2011-07-012
Number of other retired or separated participants entitled to future benefits2011-07-0150
Total of all active and inactive participants2011-07-01435
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-01435
Number of participants with account balances2011-07-01307
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-012
2010: SHAWANO MEDICAL CENTER 403(B) PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-01481
Total number of active participants reported on line 7a of the Form 55002010-07-01392
Number of retired or separated participants receiving benefits2010-07-011
Number of other retired or separated participants entitled to future benefits2010-07-0164
Total of all active and inactive participants2010-07-01457
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-01457
Number of participants with account balances2010-07-01331
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-07-015

Financial Data on SHAWANO MEDICAL CENTER 403(B) PLAN

Measure Date Value
2014 : SHAWANO MEDICAL CENTER 403(B) PLAN 2014 401k financial data
Total transfer of assets from this plan2014-06-30$8,269,752
Total income from all sources (including contributions)2014-06-30$961,669
Total of all expenses incurred2014-06-30$992,481
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$956,725
Value of total assets at end of year2014-06-30$1,559,831
Value of total assets at beginning of year2014-06-30$9,860,395
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$35,756
Total interest from all sources2014-06-30$44,110
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$157,526
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2014-06-30$157,526
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$10,000,000
If this is an individual account plan, was there a blackout period2014-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-06-30$0
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Participant contributions at end of year2014-06-30$0
Participant contributions at beginning of year2014-06-30$63,459
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$-30,812
Value of net assets at end of year (total assets less liabilities)2014-06-30$1,559,831
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$9,860,395
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$1,056,441
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$7,153,734
Interest on participant loans2014-06-30$1,721
Interest earned on other investments2014-06-30$42,389
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-06-30$503,390
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-06-30$2,643,202
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$760,033
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30No
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$956,725
Contract administrator fees2014-06-30$35,756
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-06-30No
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30Yes
Opinion of an independent qualified public accountant for this plan2014-06-30Disclaimer
Accountancy firm name2014-06-30SCHENCK SC
Accountancy firm EIN2014-06-30391173131
2013 : SHAWANO MEDICAL CENTER 403(B) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$5,660
Total income from all sources (including contributions)2013-06-30$1,070,358
Total loss/gain on sale of assets2013-06-30$0
Total of all expenses incurred2013-06-30$612,797
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$537,519
Expenses. Certain deemed distributions of participant loans2013-06-30$5,964
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$0
Value of total assets at end of year2013-06-30$9,860,395
Value of total assets at beginning of year2013-06-30$9,408,494
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$69,314
Total interest from all sources2013-06-30$65,824
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$157,300
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2013-06-30$157,300
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$10,000,000
If this is an individual account plan, was there a blackout period2013-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-06-30$0
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Participant contributions at end of year2013-06-30$63,459
Participant contributions at beginning of year2013-06-30$90,926
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-06-30$5,661
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-06-30$5,660
Total non interest bearing cash at beginning of year2013-06-30$2
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$457,561
Value of net assets at end of year (total assets less liabilities)2013-06-30$9,860,395
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$9,402,834
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-06-30$7,153,734
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$6,504,950
Interest on participant loans2013-06-30$3,332
Interest earned on other investments2013-06-30$62,487
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-06-30$42,208
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-06-30$42,208
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-06-30$5
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-06-30$2,643,202
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-06-30$2,764,747
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-06-30$847,234
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30No
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$537,519
Contract administrator fees2013-06-30$69,314
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30Yes
Opinion of an independent qualified public accountant for this plan2013-06-30Disclaimer
Accountancy firm name2013-06-30SCHENCK BUSINESS SOLUTIONS
Accountancy firm EIN2013-06-30391173131
2012 : SHAWANO MEDICAL CENTER 403(B) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$5,660
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$9,487
Total income from all sources (including contributions)2012-06-30$156,532
Total loss/gain on sale of assets2012-06-30$0
Total of all expenses incurred2012-06-30$702,962
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$649,026
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$0
Value of total assets at end of year2012-06-30$9,408,494
Value of total assets at beginning of year2012-06-30$9,958,751
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$53,936
Total interest from all sources2012-06-30$82,780
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$125,976
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2012-06-30$125,976
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$6,000,000
If this is an individual account plan, was there a blackout period2012-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-06-30$0
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Participant contributions at end of year2012-06-30$90,926
Participant contributions at beginning of year2012-06-30$123,344
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-06-30$5,661
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-06-30$9,488
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-06-30$5,660
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-06-30$7,608
Total non interest bearing cash at end of year2012-06-30$2
Total non interest bearing cash at beginning of year2012-06-30$2
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$-546,430
Value of net assets at end of year (total assets less liabilities)2012-06-30$9,402,834
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$9,949,264
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-06-30$6,504,950
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-06-30$6,844,204
Interest on participant loans2012-06-30$3,697
Interest earned on other investments2012-06-30$79,081
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-06-30$42,208
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-06-30$13,870
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-06-30$13,870
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-06-30$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-06-30$2,764,747
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-06-30$2,967,843
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-06-30$-52,224
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30No
Was there a failure to transmit to the plan any participant contributions2012-06-30No
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$649,026
Contract administrator fees2012-06-30$53,936
Liabilities. Value of benefit claims payable at beginning of year2012-06-30$1,879
Did the plan have assets held for investment2012-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30Yes
Opinion of an independent qualified public accountant for this plan2012-06-30Disclaimer
Accountancy firm name2012-06-30SCHENCK SC
Accountancy firm EIN2012-06-30391173131
2011 : SHAWANO MEDICAL CENTER 403(B) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$9,487
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$45,543
Total income from all sources (including contributions)2011-06-30$2,474,005
Total loss/gain on sale of assets2011-06-30$0
Total of all expenses incurred2011-06-30$993,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$936,750
Value of total corrective distributions2011-06-30$2,037
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$827,659
Value of total assets at end of year2011-06-30$9,958,751
Value of total assets at beginning of year2011-06-30$8,514,028
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$54,439
Total interest from all sources2011-06-30$103,193
Total dividends received (eg from common stock, registered investment company shares)2011-06-30$130,559
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2011-06-30$130,559
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$1,000,000
If this is an individual account plan, was there a blackout period2011-06-30Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-06-30$0
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$603,279
Participant contributions at end of year2011-06-30$123,344
Participant contributions at beginning of year2011-06-30$48,585
Participant contributions at beginning of year2011-06-30$186
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-06-30$9,488
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-06-30$8,003
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-06-30$7,608
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-06-30$45,543
Total non interest bearing cash at end of year2011-06-30$2
Total non interest bearing cash at beginning of year2011-06-30$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$1,480,779
Value of net assets at end of year (total assets less liabilities)2011-06-30$9,949,264
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$8,468,485
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-06-30$6,844,204
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-06-30$5,721,213
Interest on participant loans2011-06-30$2,916
Interest earned on other investments2011-06-30$100,275
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-06-30$13,870
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-06-30$49,749
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-06-30$49,749
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-06-30$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-06-30$2,967,843
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-06-30$2,686,289
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-06-30$1,412,594
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30No
Was there a failure to transmit to the plan any participant contributions2011-06-30No
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$224,380
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$936,750
Contract administrator fees2011-06-30$54,439
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-06-30Yes
Liabilities. Value of benefit claims payable at end of year2011-06-30$1,879
Did the plan have assets held for investment2011-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30Yes
Opinion of an independent qualified public accountant for this plan2011-06-30Disclaimer
Accountancy firm name2011-06-30WIPFLI, LLP
Accountancy firm EIN2011-06-30390758449

Form 5500 Responses for SHAWANO MEDICAL CENTER 403(B) PLAN

2013: SHAWANO MEDICAL CENTER 403(B) PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: SHAWANO MEDICAL CENTER 403(B) PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: SHAWANO MEDICAL CENTER 403(B) PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2010: SHAWANO MEDICAL CENTER 403(B) PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – TrustYes
2010-07-01Plan benefit arrangement – InsuranceYes
2010-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberCR 15120
Policy instance 1
Insurance contract or identification numberCR 15120
Number of Individuals Covered62
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,546
Total amount of fees paid to insurance companyUSD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,546
Insurance broker organization code?4
Insurance broker nameVSR FINANCIAL SERVICES INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892867-007
Policy instance 2
Insurance contract or identification number892867-007
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892867-007
Policy instance 1
Insurance contract or identification number892867-007
Number of Individuals Covered241
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $4,151
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
Commission paid to Insurance BrokerUSD $4,151
Insurance broker organization code?4
Insurance broker nameVSR FINANCIAL SERVICES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberCR 15120
Policy instance 2
Insurance contract or identification numberCR 15120
Number of Individuals Covered78
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $3,489
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
Commission paid to Insurance BrokerUSD $3,489
Insurance broker organization code?4
Insurance broker nameVSR FINANCIAL SERVICES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892867-007
Policy instance 1
Insurance contract or identification number892867-007
Number of Individuals Covered252
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $4,336
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberCR 15120
Policy instance 2
Insurance contract or identification numberCR 15120
Number of Individuals Covered86
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,597
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892867-007
Policy instance 1
Insurance contract or identification number892867-007
Number of Individuals Covered277
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,595
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberCR 15120
Policy instance 2
Insurance contract or identification numberCR 15120
Number of Individuals Covered91
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $3,630
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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