SIOUXLAND OBSTETRICS & GYNECOLOGY PC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL
401k plan membership statisitcs for SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL
| Measure | Date | Value |
|---|
| 2016: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 31 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 25 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 6 |
| Total of all active and inactive participants | 2016-01-01 | 33 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 0 |
| Total participants | 2016-01-01 | 33 |
| Number of participants with account balances | 2016-01-01 | 33 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-01-01 | 1 |
| 2015: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 33 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 27 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 3 |
| Total of all active and inactive participants | 2015-01-01 | 30 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-01-01 | 0 |
| Total participants | 2015-01-01 | 30 |
| Number of participants with account balances | 2015-01-01 | 28 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-01-01 | 1 |
| 2014: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 31 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 27 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 5 |
| Total of all active and inactive participants | 2014-01-01 | 32 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 32 |
| Number of participants with account balances | 2014-01-01 | 31 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 0 |
| 2013: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 30 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 27 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 4 |
| Total of all active and inactive participants | 2013-01-01 | 31 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 31 |
| Number of participants with account balances | 2013-01-01 | 31 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 1 |
| 2012: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 27 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 29 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 1 |
| Total of all active and inactive participants | 2012-01-01 | 30 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 30 |
| Number of participants with account balances | 2012-01-01 | 23 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 1 |
| 2011: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 28 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 23 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 2 |
| Total of all active and inactive participants | 2011-01-01 | 25 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 25 |
| Number of participants with account balances | 2011-01-01 | 24 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2009: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 26 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 27 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 27 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 27 |
| Number of participants with account balances | 2009-01-01 | 23 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2016 : SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $814,851 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $55,862 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $53,317 |
| Total plan assets at end of year | 2016-12-31 | $6,609,233 |
| Total plan assets at beginning of year | 2016-12-31 | $5,850,244 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $136,936 |
| Contributions received from other sources (not participants or employers) | 2016-12-31 | $10,402 |
| Other income received | 2016-12-31 | $423,615 |
| Net income (gross income less expenses) | 2016-12-31 | $758,989 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $6,609,233 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $5,850,244 |
| Assets. Value of participant loans | 2016-12-31 | $96,195 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $243,898 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $2,545 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2016-12-31 | $0 |
| 2015 : SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $328,350 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $232,388 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $230,698 |
| Total plan assets at end of year | 2015-12-31 | $5,850,244 |
| Total plan assets at beginning of year | 2015-12-31 | $5,754,282 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $134,963 |
| Other income received | 2015-12-31 | $-55,011 |
| Net income (gross income less expenses) | 2015-12-31 | $95,962 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $5,850,244 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $5,754,282 |
| Assets. Value of participant loans | 2015-12-31 | $74,937 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $248,398 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $1,690 |
| 2014 : SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $734,571 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $133,987 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $132,357 |
| Total plan assets at end of year | 2014-12-31 | $5,754,282 |
| Total plan assets at beginning of year | 2014-12-31 | $5,153,698 |
| Value of fidelity bond covering the plan | 2014-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $127,710 |
| Other income received | 2014-12-31 | $363,843 |
| Net income (gross income less expenses) | 2014-12-31 | $600,584 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $5,754,282 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $5,153,698 |
| Assets. Value of participant loans | 2014-12-31 | $81,875 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $243,018 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $1,630 |
| 2013 : SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2013 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2013-12-31 | $2,146 |
| Total income from all sources | 2013-12-31 | $1,307,178 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $5,546 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $4,136 |
| Total plan assets at end of year | 2013-12-31 | $5,153,698 |
| Total plan assets at beginning of year | 2013-12-31 | $3,854,212 |
| Value of fidelity bond covering the plan | 2013-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $117,657 |
| Contributions received from other sources (not participants or employers) | 2013-12-31 | $16,487 |
| Other income received | 2013-12-31 | $932,154 |
| Net income (gross income less expenses) | 2013-12-31 | $1,301,632 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $5,153,698 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $3,852,066 |
| Assets. Value of participant loans | 2013-12-31 | $90,512 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $240,880 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $1,410 |
| 2012 : SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-12-31 | $2,146 |
| Total income from all sources | 2012-12-31 | $848,303 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $146,327 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $142,779 |
| Total plan assets at end of year | 2012-12-31 | $3,854,212 |
| Total plan assets at beginning of year | 2012-12-31 | $3,150,090 |
| Value of fidelity bond covering the plan | 2012-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $103,455 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $49,855 |
| Other income received | 2012-12-31 | $481,715 |
| Net income (gross income less expenses) | 2012-12-31 | $701,976 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $3,852,066 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $3,150,090 |
| Assets. Value of participant loans | 2012-12-31 | $102,978 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $213,278 |
| Value of corrective distributions | 2012-12-31 | $2,146 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $1,402 |
| 2011 : SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $197,010 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $25,676 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $24,176 |
| Total plan assets at end of year | 2011-12-31 | $3,150,090 |
| Total plan assets at beginning of year | 2011-12-31 | $2,978,756 |
| Value of fidelity bond covering the plan | 2011-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $91,259 |
| Other income received | 2011-12-31 | $-81,155 |
| Net income (gross income less expenses) | 2011-12-31 | $171,334 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $3,150,090 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $2,978,756 |
| Assets. Value of participant loans | 2011-12-31 | $117,013 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $186,906 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $1,500 |
| 2010 : SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $630,753 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $736,921 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $735,661 |
| Total plan assets at end of year | 2010-12-31 | $2,978,756 |
| Total plan assets at beginning of year | 2010-12-31 | $3,084,924 |
| Value of fidelity bond covering the plan | 2010-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $100,129 |
| Other income received | 2010-12-31 | $328,478 |
| Net income (gross income less expenses) | 2010-12-31 | $-106,168 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $2,978,756 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $3,084,924 |
| Assets. Value of participant loans | 2010-12-31 | $73,208 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $202,146 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $1,260 |
| 2016: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: SIOUXLAND OBSTETRICS & GYNECOLOGY PC 401(K) P/S PL 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 funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 44129 |
| Policy instance | 1 |
| Insurance contract or identification number | 44129 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 209 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN MUTUAL LIFE |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 44129 |
| Policy instance | 1 |
| Insurance contract or identification number | 44129 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $204 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN MUTUAL LIFE |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 2038617 |
| Policy instance | 4 |
| Insurance contract or identification number | 2038617 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | GERALD J BAURDEAUX |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 1960396 |
| Policy instance | 1 |
| Insurance contract or identification number | 1960396 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 44129 |
| Policy instance | 2 |
| Insurance contract or identification number | 44129 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 200 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN MUTUAL LIFE |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | W541213 |
| Policy instance | 3 |
| Insurance contract or identification number | W541213 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | STANLEY C RHINEHART |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 1960396 |
| Policy instance | 1 |
| Insurance contract or identification number | 1960396 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 2038617 |
| Policy instance | 4 |
| Insurance contract or identification number | 2038617 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | GERALD J BAURDEAUX |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | W541213 |
| Policy instance | 3 |
| Insurance contract or identification number | W541213 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | STANLEY C RHINEHART |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 44129 |
| Policy instance | 2 |
| Insurance contract or identification number | 44129 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of fees paid to insurance company | USD $196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 196 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN MUTUAL LIFE |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | W541213 |
| Policy instance | 3 |
| Insurance contract or identification number | W541213 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 44129 |
| Policy instance | 2 |
| Insurance contract or identification number | 44129 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 1960396 |
| Policy instance | 1 |
| Insurance contract or identification number | 1960396 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 2038617 |
| Policy instance | 4 |
| Insurance contract or identification number | 2038617 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 2038617 |
| Policy instance | 4 |
| Insurance contract or identification number | 2038617 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | GERALD J BAURDEAUX |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 44129 |
| Policy instance | 2 |
| Insurance contract or identification number | 44129 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KNIGHTS OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 58033 ) |
| Policy contract number | 1960396 |
| Policy instance | 1 |
| Insurance contract or identification number | 1960396 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | W541213 |
| Policy instance | 3 |
| Insurance contract or identification number | W541213 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2 | | 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 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | STANLEY C RHINEHART |
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