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VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 401k Plan overview

Plan NameVILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN
Plan identification number 502

VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

VILLAGE NORTHWEST UNLIMITED has sponsored the creation of one or more 401k plans.

Company Name:VILLAGE NORTHWEST UNLIMITED
Employer identification number (EIN):421044017
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about VILLAGE NORTHWEST UNLIMITED

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 1976-01-14
Company Identification Number: 058413
Legal Registered Office Address: 330 VILLAGE CIR

SHELDON
United States of America (USA)
51201

More information about VILLAGE NORTHWEST UNLIMITED

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-07-01BARRY WHITSELL2023-03-20
5022020-07-01BARRY W WHITSELL2022-04-14
5022019-07-01BARRY W WHITSELL2021-03-12
5022018-07-01BARRY WHITSELL2020-03-05
5022017-07-01BARRY WHITSELL
5022016-07-01
5022015-07-01
5022014-07-01
5022013-07-01BARRY WHITSELL
5022012-07-01BARRY WHITSELL
5022011-07-01BARRY WHITSELL
5022009-07-01BARRY WHITSELL

Plan Statistics for VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN

401k plan membership statisitcs for VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN

Measure Date Value
2021: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01134
Total number of active participants reported on line 7a of the Form 55002021-07-01126
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01126
2020: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01150
Total number of active participants reported on line 7a of the Form 55002020-07-01134
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01134
2019: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01150
Total number of active participants reported on line 7a of the Form 55002019-07-01150
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01150
2018: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01170
Total number of active participants reported on line 7a of the Form 55002018-07-01150
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01150
2017: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01160
Total number of active participants reported on line 7a of the Form 55002017-07-01170
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01170
2016: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01171
Total number of active participants reported on line 7a of the Form 55002016-07-01160
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01160
2015: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01172
Total number of active participants reported on line 7a of the Form 55002015-07-01171
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01171
2014: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01170
Total number of active participants reported on line 7a of the Form 55002014-07-01172
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01172
2013: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01178
Total number of active participants reported on line 7a of the Form 55002013-07-01170
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01170
2012: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01179
Total number of active participants reported on line 7a of the Form 55002012-07-01178
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01178
2011: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01187
Total number of active participants reported on line 7a of the Form 55002011-07-01179
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01179
2009: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01200
Total number of active participants reported on line 7a of the Form 55002009-07-01196
Number of retired or separated participants receiving benefits2009-07-011
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01197

Financial Data on VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN

Measure Date Value
2022 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-06-30$-494,390
Total unrealized appreciation/depreciation of assets2022-06-30$-494,390
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$152,172
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$144,536
Total income from all sources (including contributions)2022-06-30$1,153,719
Total of all expenses incurred2022-06-30$1,532,526
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$1,425,724
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$1,570,303
Value of total assets at end of year2022-06-30$5,198,089
Value of total assets at beginning of year2022-06-30$5,569,260
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$106,802
Total interest from all sources2022-06-30$13,184
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$64,622
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2022-06-30$64,622
Administrative expenses professional fees incurred2022-06-30$9,651
Was this plan covered by a fidelity bond2022-06-30No
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$502,499
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-06-30$18,072
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-06-30$1,416
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-06-30$4,260
Administrative expenses (other) incurred2022-06-30$210
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-378,807
Value of net assets at end of year (total assets less liabilities)2022-06-30$5,045,917
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$5,424,724
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-06-30$2,354,616
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-06-30$2,239,197
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-06-30$2,664,954
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-06-30$3,055,555
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-06-30$3,055,555
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-06-30$13,184
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$203,081
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$1,067,804
Employer contributions (assets) at end of year2022-06-30$177,103
Employer contributions (assets) at beginning of year2022-06-30$270,248
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$1,204,571
Contract administrator fees2022-06-30$96,941
Liabilities. Value of benefit claims payable at end of year2022-06-30$152,172
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$144,536
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2022-06-30420794029
2021 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-06-30$717,423
Total unrealized appreciation/depreciation of assets2021-06-30$717,423
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$144,536
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$338,972
Total income from all sources (including contributions)2021-06-30$2,529,625
Total of all expenses incurred2021-06-30$1,723,379
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$1,609,918
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$1,737,169
Value of total assets at end of year2021-06-30$5,569,260
Value of total assets at beginning of year2021-06-30$4,957,450
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$113,461
Total interest from all sources2021-06-30$44,389
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$30,644
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2021-06-30$30,644
Administrative expenses professional fees incurred2021-06-30$9,375
Was this plan covered by a fidelity bond2021-06-30No
If this is an individual account plan, was there a blackout period2021-06-30No
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$575,543
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-06-30$1,485
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-06-30$4,260
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-06-30$12,463
Administrative expenses (other) incurred2021-06-30$150
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$806,246
Value of net assets at end of year (total assets less liabilities)2021-06-30$5,424,724
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$4,618,478
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-06-30$2,239,197
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-06-30$1,491,130
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-06-30$3,055,555
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-06-30$3,065,741
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-06-30$3,065,741
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-06-30$44,389
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$195,516
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30No
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$1,161,626
Employer contributions (assets) at end of year2021-06-30$270,248
Employer contributions (assets) at beginning of year2021-06-30$388,116
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$1,412,917
Contract administrator fees2021-06-30$103,936
Liabilities. Value of benefit claims payable at end of year2021-06-30$144,536
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$338,972
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Unqualified
Accountancy firm name2021-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2021-06-30420794029
2020 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-06-30$-18,885
Total unrealized appreciation/depreciation of assets2020-06-30$-18,885
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$338,972
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$167,652
Total income from all sources (including contributions)2020-06-30$1,869,549
Total of all expenses incurred2020-06-30$2,045,534
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$1,930,816
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$1,788,899
Value of total assets at end of year2020-06-30$4,957,450
Value of total assets at beginning of year2020-06-30$4,962,115
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$114,718
Total interest from all sources2020-06-30$64,359
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$35,176
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2020-06-30$35,176
Administrative expenses professional fees incurred2020-06-30$9,257
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$500,000
If this is an individual account plan, was there a blackout period2020-06-30No
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$487,876
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-06-30$26,499
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-06-30$12,463
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-06-30$17,193
Administrative expenses (other) incurred2020-06-30$181
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$-175,985
Value of net assets at end of year (total assets less liabilities)2020-06-30$4,618,478
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$4,794,463
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-06-30$1,491,130
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-06-30$1,209,845
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-06-30$3,065,741
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-06-30$3,430,466
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-06-30$3,430,466
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-06-30$64,359
Expenses. Payments to insurance carriers foe the provision of benefits2020-06-30$196,522
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30No
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$1,301,023
Employer contributions (assets) at end of year2020-06-30$388,116
Employer contributions (assets) at beginning of year2020-06-30$304,611
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$1,707,795
Contract administrator fees2020-06-30$105,280
Liabilities. Value of benefit claims payable at end of year2020-06-30$338,972
Liabilities. Value of benefit claims payable at beginning of year2020-06-30$167,652
Did the plan have assets held for investment2020-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30No
Opinion of an independent qualified public accountant for this plan2020-06-30Unqualified
Accountancy firm name2020-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2020-06-30420794029
2019 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-06-30$23,122
Total unrealized appreciation/depreciation of assets2019-06-30$23,122
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$167,652
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$218,776
Total income from all sources (including contributions)2019-06-30$2,203,001
Total of all expenses incurred2019-06-30$2,096,790
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$1,975,464
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$2,092,196
Value of total assets at end of year2019-06-30$4,962,115
Value of total assets at beginning of year2019-06-30$4,907,028
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$121,326
Total interest from all sources2019-06-30$56,295
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$31,388
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2019-06-30$31,388
Administrative expenses professional fees incurred2019-06-30$9,010
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$500,000
If this is an individual account plan, was there a blackout period2019-06-30No
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$569,485
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-06-30$29,807
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-06-30$17,193
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-06-30$6,328
Administrative expenses (other) incurred2019-06-30$151
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$106,211
Value of net assets at end of year (total assets less liabilities)2019-06-30$4,794,463
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$4,688,252
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-06-30$1,209,845
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-06-30$1,155,335
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-06-30$3,430,466
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-06-30$3,521,518
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-06-30$3,521,518
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-06-30$56,295
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$200,929
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$1,522,711
Employer contributions (assets) at end of year2019-06-30$304,611
Employer contributions (assets) at beginning of year2019-06-30$223,847
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$1,744,728
Contract administrator fees2019-06-30$112,165
Liabilities. Value of benefit claims payable at end of year2019-06-30$167,652
Liabilities. Value of benefit claims payable at beginning of year2019-06-30$218,776
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30No
Opinion of an independent qualified public accountant for this plan2019-06-30Unqualified
Accountancy firm name2019-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2019-06-30420794029
2018 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-06-30$52,675
Total unrealized appreciation/depreciation of assets2018-06-30$52,675
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$218,776
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$105,807
Total income from all sources (including contributions)2018-06-30$2,166,644
Total loss/gain on sale of assets2018-06-30$0
Total of all expenses incurred2018-06-30$1,881,465
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$1,760,115
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$2,071,956
Value of total assets at end of year2018-06-30$4,907,028
Value of total assets at beginning of year2018-06-30$4,508,880
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$121,350
Total interest from all sources2018-06-30$24,207
Total dividends received (eg from common stock, registered investment company shares)2018-06-30$17,806
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2018-06-30$17,806
Administrative expenses professional fees incurred2018-06-30$8,000
Was this plan covered by a fidelity bond2018-06-30Yes
Value of fidelity bond cover2018-06-30$500,000
If this is an individual account plan, was there a blackout period2018-06-30No
Were there any nonexempt tranactions with any party-in-interest2018-06-30No
Contributions received from participants2018-06-30$603,609
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-06-30$27,408
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-06-30$6,328
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-06-30$3,584
Administrative expenses (other) incurred2018-06-30$153
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Value of net income/loss2018-06-30$285,179
Value of net assets at end of year (total assets less liabilities)2018-06-30$4,688,252
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$4,403,073
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-06-30No
Were any leases to which the plan was party in default or uncollectible2018-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-06-30$1,155,335
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-06-30$1,084,855
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-06-30$3,521,518
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-06-30$3,120,441
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-06-30$3,120,441
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-06-30$24,207
Expenses. Payments to insurance carriers foe the provision of benefits2018-06-30$207,618
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-06-30No
Was there a failure to transmit to the plan any participant contributions2018-06-30No
Has the plan failed to provide any benefit when due under the plan2018-06-30No
Contributions received in cash from employer2018-06-30$1,468,347
Employer contributions (assets) at end of year2018-06-30$223,847
Employer contributions (assets) at beginning of year2018-06-30$300,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-06-30$1,525,089
Contract administrator fees2018-06-30$113,197
Liabilities. Value of benefit claims payable at end of year2018-06-30$218,776
Liabilities. Value of benefit claims payable at beginning of year2018-06-30$105,807
Did the plan have assets held for investment2018-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-06-30No
Opinion of an independent qualified public accountant for this plan2018-06-30Unqualified
Accountancy firm name2018-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2018-06-30420794029
2017 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-06-30$72,335
Total unrealized appreciation/depreciation of assets2017-06-30$72,335
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$105,807
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$176,763
Total income from all sources (including contributions)2017-06-30$2,117,700
Total loss/gain on sale of assets2017-06-30$0
Total of all expenses incurred2017-06-30$1,767,955
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$1,633,356
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$2,016,186
Value of total assets at end of year2017-06-30$4,508,880
Value of total assets at beginning of year2017-06-30$4,230,091
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$134,599
Total interest from all sources2017-06-30$17,015
Total dividends received (eg from common stock, registered investment company shares)2017-06-30$12,164
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2017-06-30$12,164
Administrative expenses professional fees incurred2017-06-30$15,125
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$500,000
If this is an individual account plan, was there a blackout period2017-06-30No
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$563,240
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-06-30$26,707
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-06-30$3,584
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-06-30$1,871
Administrative expenses (other) incurred2017-06-30$151
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Value of net income/loss2017-06-30$349,745
Value of net assets at end of year (total assets less liabilities)2017-06-30$4,403,073
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$4,053,328
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-06-30$1,084,855
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-06-30$1,000,356
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-06-30$3,120,441
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-06-30$2,501,432
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-06-30$2,501,432
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-06-30$17,015
Expenses. Payments to insurance carriers foe the provision of benefits2017-06-30$206,642
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30No
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Contributions received in cash from employer2017-06-30$1,452,946
Employer contributions (assets) at end of year2017-06-30$300,000
Employer contributions (assets) at beginning of year2017-06-30$726,432
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-06-30$1,400,007
Contract administrator fees2017-06-30$119,323
Liabilities. Value of benefit claims payable at end of year2017-06-30$105,807
Liabilities. Value of benefit claims payable at beginning of year2017-06-30$176,763
Did the plan have assets held for investment2017-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30No
Opinion of an independent qualified public accountant for this plan2017-06-30Unqualified
Accountancy firm name2017-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2017-06-30420794029
2016 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-06-30$-91,199
Total unrealized appreciation/depreciation of assets2016-06-30$-91,199
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$176,763
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$240,435
Total income from all sources (including contributions)2016-06-30$2,081,812
Total loss/gain on sale of assets2016-06-30$0
Total of all expenses incurred2016-06-30$1,841,494
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$1,722,446
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$2,102,350
Value of total assets at end of year2016-06-30$4,230,091
Value of total assets at beginning of year2016-06-30$4,053,445
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$119,048
Total interest from all sources2016-06-30$14,117
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$56,544
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2016-06-30$56,544
Administrative expenses professional fees incurred2016-06-30$2,250
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$500,000
If this is an individual account plan, was there a blackout period2016-06-30No
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Contributions received from participants2016-06-30$523,436
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-06-30$1,871
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-06-30$2,283
Administrative expenses (other) incurred2016-06-30$151
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$240,318
Value of net assets at end of year (total assets less liabilities)2016-06-30$4,053,328
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$3,813,010
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$1,000,356
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$1,035,011
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-06-30$2,501,432
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-06-30$2,668,633
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-06-30$2,668,633
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-06-30$14,117
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$200,474
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30No
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$1,578,914
Employer contributions (assets) at end of year2016-06-30$726,432
Employer contributions (assets) at beginning of year2016-06-30$347,518
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-06-30$1,521,972
Contract administrator fees2016-06-30$116,647
Liabilities. Value of benefit claims payable at end of year2016-06-30$176,763
Liabilities. Value of benefit claims payable at beginning of year2016-06-30$240,435
Did the plan have assets held for investment2016-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2016-06-30420794029
2015 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-06-30$2,776
Total unrealized appreciation/depreciation of assets2015-06-30$2,776
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$240,435
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$189,026
Total income from all sources (including contributions)2015-06-30$2,416,526
Total loss/gain on sale of assets2015-06-30$0
Total of all expenses incurred2015-06-30$2,013,565
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$1,906,948
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$2,333,118
Value of total assets at end of year2015-06-30$4,053,445
Value of total assets at beginning of year2015-06-30$3,599,075
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$106,617
Total interest from all sources2015-06-30$13,126
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$67,506
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2015-06-30$67,506
Administrative expenses professional fees incurred2015-06-30$5,000
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$500,000
If this is an individual account plan, was there a blackout period2015-06-30No
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$490,037
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-06-30$28,563
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-06-30$2,283
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-06-30$1,090
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$402,961
Value of net assets at end of year (total assets less liabilities)2015-06-30$3,813,010
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$3,410,049
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$1,035,011
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$964,729
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-06-30$2,668,633
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-06-30$2,244,818
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-06-30$2,244,818
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-06-30$13,126
Expenses. Payments to insurance carriers foe the provision of benefits2015-06-30$187,591
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30No
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$1,843,081
Employer contributions (assets) at end of year2015-06-30$347,518
Employer contributions (assets) at beginning of year2015-06-30$388,438
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$1,690,794
Contract administrator fees2015-06-30$101,617
Liabilities. Value of benefit claims payable at end of year2015-06-30$240,435
Liabilities. Value of benefit claims payable at beginning of year2015-06-30$189,026
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30No
Opinion of an independent qualified public accountant for this plan2015-06-30Unqualified
Accountancy firm name2015-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2015-06-30420794029
2014 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-06-30$102,033
Total unrealized appreciation/depreciation of assets2014-06-30$102,033
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$189,026
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$338,513
Total income from all sources (including contributions)2014-06-30$2,908,826
Total loss/gain on sale of assets2014-06-30$0
Total of all expenses incurred2014-06-30$2,017,747
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$1,934,590
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$2,751,266
Value of total assets at end of year2014-06-30$3,599,075
Value of total assets at beginning of year2014-06-30$2,857,483
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$83,157
Total interest from all sources2014-06-30$6,108
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$49,419
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$49,419
Administrative expenses professional fees incurred2014-06-30$7,100
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$250,000
If this is an individual account plan, was there a blackout period2014-06-30No
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$612,828
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-06-30$1,090
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-06-30$950
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$891,079
Value of net assets at end of year (total assets less liabilities)2014-06-30$3,410,049
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$2,518,970
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$964,729
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$813,277
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-06-30$2,244,818
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-06-30$1,684,012
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-06-30$1,684,012
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-06-30$6,108
Expenses. Payments to insurance carriers foe the provision of benefits2014-06-30$232,584
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
Contributions received in cash from employer2014-06-30$2,138,438
Employer contributions (assets) at end of year2014-06-30$388,438
Employer contributions (assets) at beginning of year2014-06-30$359,244
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$1,702,006
Contract administrator fees2014-06-30$76,057
Liabilities. Value of benefit claims payable at end of year2014-06-30$189,026
Liabilities. Value of benefit claims payable at beginning of year2014-06-30$338,513
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)2014-06-30No
Opinion of an independent qualified public accountant for this plan2014-06-30Unqualified
Accountancy firm name2014-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2014-06-30420794029
2013 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-06-30$7,833
Total unrealized appreciation/depreciation of assets2013-06-30$7,833
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$338,513
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$231,434
Total income from all sources (including contributions)2013-06-30$2,647,312
Total loss/gain on sale of assets2013-06-30$36,049
Total of all expenses incurred2013-06-30$2,270,621
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$2,194,445
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$2,584,948
Value of total assets at end of year2013-06-30$2,857,483
Value of total assets at beginning of year2013-06-30$2,373,713
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$76,176
Total interest from all sources2013-06-30$8,644
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$9,838
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$9,838
Administrative expenses professional fees incurred2013-06-30$7,766
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$250,000
If this is an individual account plan, was there a blackout period2013-06-30No
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$475,704
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-06-30$950
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-06-30$1,847
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$376,691
Value of net assets at end of year (total assets less liabilities)2013-06-30$2,518,970
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$2,142,279
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$813,277
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$509,557
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-06-30$1,684,012
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-06-30$1,000,823
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-06-30$1,000,823
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-06-30$8,644
Expenses. Payments to insurance carriers foe the provision of benefits2013-06-30$197,773
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
Contributions received in cash from employer2013-06-30$2,109,244
Employer contributions (assets) at end of year2013-06-30$359,244
Employer contributions (assets) at beginning of year2013-06-30$861,486
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$1,996,672
Contract administrator fees2013-06-30$68,410
Liabilities. Value of benefit claims payable at end of year2013-06-30$338,513
Liabilities. Value of benefit claims payable at beginning of year2013-06-30$231,434
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
Aggregate proceeds on sale of assets2013-06-30$866,160
Aggregate carrying amount (costs) on sale of assets2013-06-30$830,111
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30No
Opinion of an independent qualified public accountant for this plan2013-06-30Unqualified
Accountancy firm name2013-06-30DENMAN & COMPANY LLP
Accountancy firm EIN2013-06-30420794029
2012 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-06-30$9,106
Total unrealized appreciation/depreciation of assets2012-06-30$9,106
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$231,434
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$215,937
Total income from all sources (including contributions)2012-06-30$2,668,563
Total loss/gain on sale of assets2012-06-30$0
Total of all expenses incurred2012-06-30$2,492,946
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$2,418,288
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$2,639,079
Value of total assets at end of year2012-06-30$2,373,713
Value of total assets at beginning of year2012-06-30$2,182,599
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$74,658
Total interest from all sources2012-06-30$12,444
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$7,934
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Administrative expenses professional fees incurred2012-06-30$7,070
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$250,000
If this is an individual account plan, was there a blackout period2012-06-30No
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$527,593
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-06-30$1,847
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-06-30$1,402
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$175,617
Value of net assets at end of year (total assets less liabilities)2012-06-30$2,142,279
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$1,966,662
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$509,557
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-06-30$492,518
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-06-30$1,000,823
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-06-30$1,422,153
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-06-30$1,422,153
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-06-30$12,444
Expenses. Payments to insurance carriers foe the provision of benefits2012-06-30$188,943
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
Contributions received in cash from employer2012-06-30$2,111,486
Employer contributions (assets) at end of year2012-06-30$861,486
Employer contributions (assets) at beginning of year2012-06-30$266,526
Income. Dividends from common stock2012-06-30$7,934
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$2,229,345
Contract administrator fees2012-06-30$67,588
Liabilities. Value of benefit claims payable at end of year2012-06-30$231,434
Liabilities. Value of benefit claims payable at beginning of year2012-06-30$215,937
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)2012-06-30No
Opinion of an independent qualified public accountant for this plan2012-06-30Unqualified
Accountancy firm name2012-06-30DENMAN & COMPANY LLC
Accountancy firm EIN2012-06-30420794029
2011 : VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-06-30$57,173
Total unrealized appreciation/depreciation of assets2011-06-30$57,173
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$215,937
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$277,125
Total income from all sources (including contributions)2011-06-30$2,799,593
Total loss/gain on sale of assets2011-06-30$0
Total of all expenses incurred2011-06-30$2,310,139
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$2,231,462
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$2,726,490
Value of total assets at end of year2011-06-30$2,182,599
Value of total assets at beginning of year2011-06-30$1,754,333
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$78,677
Total interest from all sources2011-06-30$11,065
Total dividends received (eg from common stock, registered investment company shares)2011-06-30$4,865
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Administrative expenses professional fees incurred2011-06-30$6,750
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$250,000
If this is an individual account plan, was there a blackout period2011-06-30No
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$509,964
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-06-30$1,402
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-06-30$143
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$489,454
Value of net assets at end of year (total assets less liabilities)2011-06-30$1,966,662
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$1,477,208
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$492,518
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-06-30$630,479
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-06-30$1,422,153
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-06-30$955,056
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-06-30$955,056
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-06-30$11,065
Expenses. Payments to insurance carriers foe the provision of benefits2011-06-30$194,500
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$2,216,526
Employer contributions (assets) at end of year2011-06-30$266,526
Employer contributions (assets) at beginning of year2011-06-30$168,655
Income. Dividends from common stock2011-06-30$4,865
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$2,036,962
Contract administrator fees2011-06-30$71,927
Liabilities. Value of benefit claims payable at end of year2011-06-30$215,937
Liabilities. Value of benefit claims payable at beginning of year2011-06-30$277,125
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)2011-06-30No
Opinion of an independent qualified public accountant for this plan2011-06-30Unqualified
Accountancy firm name2011-06-30DENMAN & COMPANY LLC
Accountancy firm EIN2011-06-30420794029

Form 5500 Responses for VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN

2021: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA 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 – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA 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 – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2009: VILLAGE NORTHWEST PREMIUM CONVERSION CAFETERIA PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number226
Policy instance 3
Insurance contract or identification number226
Number of Individuals Covered108
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5959297
Policy instance 2
Insurance contract or identification number5959297
Number of Individuals Covered243
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $11,955
Total amount of fees paid to insurance companyUSD $9
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $62,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,466
Insurance broker organization code?3
Amount paid for insurance broker fees9
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number226
Policy instance 1
Insurance contract or identification number226
Number of Individuals Covered126
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $7,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,695
Additional information about fees paid to insurance brokerINDIRECT COMMISSIONS ALLOCATION
Insurance broker organization code?3
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number226
Policy instance 3
Insurance contract or identification number226
Number of Individuals Covered118
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5959297
Policy instance 2
Insurance contract or identification number5959297
Number of Individuals Covered303
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $11,847
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $61,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,847
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number226
Policy instance 1
Insurance contract or identification number226
Number of Individuals Covered134
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $8,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,470
Additional information about fees paid to insurance brokerINDIRECT COMMISSIONS ALLOCATION
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number226
Policy instance 1
Insurance contract or identification number226
Number of Individuals Covered150
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $8,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,810
Additional information about fees paid to insurance brokerINDIRECT COMMISSIONS ALLOCATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5959297
Policy instance 2
Insurance contract or identification number5959297
Number of Individuals Covered300
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $10,597
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $58,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,438
Insurance broker organization code?3
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number226
Policy instance 3
Insurance contract or identification number226
Number of Individuals Covered133
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144436
Policy instance 4
Insurance contract or identification number144436
Number of Individuals Covered48
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144436
Policy instance 4
Insurance contract or identification number144436
Number of Individuals Covered48
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,787
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $18,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,325
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number226
Policy instance 3
Insurance contract or identification number226
Number of Individuals Covered133
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number375255
Policy instance 2
Insurance contract or identification number375255
Number of Individuals Covered208
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $5,608
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $56,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,325
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number226
Policy instance 1
Insurance contract or identification number226
Number of Individuals Covered150
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $9,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,640
Additional information about fees paid to insurance brokerINDIRECT COMMISSIONS ALLOCATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144436
Policy instance 4
Insurance contract or identification number144436
Number of Individuals Covered58
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,758
Total amount of fees paid to insurance companyUSD $0
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?No
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
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $18,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number226
Policy instance 3
Insurance contract or identification number226
Number of Individuals Covered152
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
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
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number375255
Policy instance 2
Insurance contract or identification number375255
Number of Individuals Covered220
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,351
Total amount of fees paid to insurance companyUSD $0
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $49,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number226
Policy instance 1
Insurance contract or identification number226
Number of Individuals Covered170
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $9,960
Total amount of fees paid to insurance companyUSD $0
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?No
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
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number226
Policy instance 1
Insurance contract or identification number226
Number of Individuals Covered171
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $10,015
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?No
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 $10,015
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINDIRECT COMMISSIONS ALLOCATION
Insurance broker organization code?3
Insurance broker namePERSPECTIVE INSURANCE
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number375255
Policy instance 2
Insurance contract or identification number375255
Number of Individuals Covered220
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,908
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $43,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,908
Insurance broker organization code?3
Insurance broker nameARI SERVICES LTD.
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number226
Policy instance 3
Insurance contract or identification number226
Number of Individuals Covered152
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
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
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number226
Policy instance 3
Insurance contract or identification number226
Number of Individuals Covered156
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
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?No
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
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number226
Policy instance 1
Insurance contract or identification number226
Number of Individuals Covered172
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $10,205
Total amount of fees paid to insurance companyUSD $8,735
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?No
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 $10,205
Amount paid for insurance broker fees8735
Additional information about fees paid to insurance brokerINDIRECT COMMISSIONS ALLOCATION
Insurance broker organization code?3
Insurance broker namePERSPECTIVE INSURANCE
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number375255
Policy instance 2
Insurance contract or identification number375255
Number of Individuals Covered226
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,894
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $42,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,894
Insurance broker organization code?3
Insurance broker nameARI SERVICES LTD.
BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )
Policy contract number24800
Policy instance 1
Insurance contract or identification number24800
Number of Individuals Covered184
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $41,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number375255
Policy instance 2
Insurance contract or identification number375255
Number of Individuals Covered228
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,592
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $39,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,592
Insurance broker organization code?3
Insurance broker nameARI SERVICES LTD.
BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )
Policy contract number24800
Policy instance 1
Insurance contract or identification number24800
Number of Individuals Covered180
Insurance policy start date2012-10-01
Insurance policy end date2013-06-30
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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $121,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )
Policy contract number24800
Policy instance 3
Insurance contract or identification number24800
Number of Individuals Covered179
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $130,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number24800
Policy instance 2
Insurance contract or identification number24800
Number of Individuals Covered227
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $21,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number24800
Policy instance 1
Insurance contract or identification number24800
Number of Individuals Covered0
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $-292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number24800
Policy instance 1
Insurance contract or identification number24800
Number of Individuals Covered185
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $152,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number24800
Policy instance 2
Insurance contract or identification number24800
Number of Individuals Covered225
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $21,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number375255
Policy instance 3
Insurance contract or identification number375255
Number of Individuals Covered195
Insurance policy start date2010-01-01
Insurance policy end date2011-01-01
Total amount of commissions paid to insurance brokerUSD $2,405
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?No
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $16,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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