401k Plan data: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN plan

VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 401k Plan overview

Plan Name	VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN
Plan identification number	502

VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

VERSA INTEGRITY GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: VERSA INTEGRITY GROUP, INC.

Employer identification number (EIN): 461617493

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Additional information about VERSA INTEGRITY GROUP, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2013-04-25

Company Identification Number: 0801773782

Legal Registered Office Address: 14434 MEDICAL COMPLEX DR STE 100

TOMBALL
United States of America (USA)
77377

More information about VERSA INTEGRITY GROUP, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2018-01-01 OLGA ALVAREZ
502 2017-01-01
502 2016-01-01
502 2015-01-01 SCOTT BARBIER DAVID COHN 2016-04-21
502 2014-01-01 SCOTT BARBIER DAVID COHN 2015-05-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2018-01-01	OLGA ALVAREZ
502	2017-01-01
502	2016-01-01
502	2015-01-01	SCOTT BARBIER	DAVID COHN	2016-04-21
502	2014-01-01	SCOTT BARBIER	DAVID COHN	2015-05-15

Plan Statistics for VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN

401k plan membership statisitcs for VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN

Measure Date Value
2018: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 396
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
2017: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 302
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 396
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 396
2016: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 513
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 513
2015: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 184
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 191
Total of all active and inactive participants 2015-01-01 191
Total participants 2015-01-01 191
2014: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 184
Total of all active and inactive participants 2014-01-01 184
Total participants 2014-01-01 184

Measure	Date	Value
2018: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	396
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
2017: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	302
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	396
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	396
2016: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	513
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	513
2015: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	184
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	191
Total of all active and inactive participants	2015-01-01	191
Total participants	2015-01-01	191
2014: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	184
Total of all active and inactive participants	2014-01-01	184
Total participants	2014-01-01	184

Form 5500 Responses for VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN

2018: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: VERSA INTEGRITY GROUP VOLUNTARY LIFE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400000100022227

Policy instance

Insurance contract or identification number	400000100022227
Number of Individuals Covered	516
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,304
Total amount of fees paid to insurance company	USD $9,040
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $72,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,304
Insurance broker organization code?	3
Amount paid for insurance broker fees	3652
Additional information about fees paid to insurance broker	OVERRIDE

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

403006477

Policy instance

Insurance contract or identification number	403006477
Number of Individuals Covered	516
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,012
Total amount of fees paid to insurance company	USD $2,391
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
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 Carrier	USD $20,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,012
Insurance broker organization code?	3
Amount paid for insurance broker fees	1006
Additional information about fees paid to insurance broker	OVERRIDE

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

403006477

Policy instance

Insurance contract or identification number	403006477
Number of Individuals Covered	403
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,671
Total amount of fees paid to insurance company	USD $13,765
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $76,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,671
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker name	MARK S. METTILLE

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ARM5

Policy instance

Insurance contract or identification number	GVTL0ARM5
Number of Individuals Covered	191
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $4,250
Total amount of fees paid to insurance company	USD $1,108
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $60,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,250
Amount paid for insurance broker fees	1108
Insurance broker organization code?	3
Insurance broker name	GROUP INSURANCE ASSOCIATES INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ARM5

Policy instance

Insurance contract or identification number	GVTL0ARM5
Number of Individuals Covered	184
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $3,959
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $49,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $395
Insurance broker organization code?	3
Insurance broker name	GROUP INSURANCE ASSOCIATES

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Company Name:	VERSA INTEGRITY GROUP, INC.
Employer identification number (EIN):	461617493
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2013-04-25
Company Identification Number:	0801773782
Legal Registered Office Address:	14434 MEDICAL COMPLEX DR STE 100 TOMBALL United States of America (USA) 77377