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KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 401k Plan overview

Plan NameKRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN
Plan identification number 501

KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental

401k Sponsoring company profile

KRIZ-DAVIS COMPANY 2400 WEST THIRD ST has sponsored the creation of one or more 401k plans.

Company Name:KRIZ-DAVIS COMPANY 2400 WEST THIRD ST
Employer identification number (EIN):470398310
NAIC Classification:423600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-05-01TRACEY LUKASIEWICZ TRACEY LUKASIEWICZ2018-05-22
5012016-05-01TRACEY LUKASIEWICZ TRACEY LUKASIEWICZ2018-02-08
5012015-05-01TRACEY LUKASIEWICZ2016-11-21 TRACEY LUKASIEWICZ2016-11-21
5012014-05-01TRACEY LUKASIEWICZ2015-11-23 TRACEY LUKASIEWICZ2015-11-23
5012013-05-01TRACEY LUKASIEWICZ2014-12-08 TRACEY LUKASIEWICZ2014-12-08
5012012-05-01TRACEY LUKASIEWICZ2013-11-26 TRACEY LUKASIEWICZ2013-11-26
5012011-05-01TRACEY LUKASIEWICZ TRACEY LUKASIEWICZ2012-11-27
5012009-05-01TRACEY LUKASIEWICZ TRACEY LUKASIEWICZ2010-12-10

Plan Statistics for KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN

401k plan membership statisitcs for KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN

Measure Date Value
2017: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01250
Total number of active participants reported on line 7a of the Form 55002017-05-010
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-010
2016: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01248
Total number of active participants reported on line 7a of the Form 55002016-05-01250
Number of retired or separated participants receiving benefits2016-05-0118
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-01268
2015: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-01246
Total number of active participants reported on line 7a of the Form 55002015-05-01248
Number of retired or separated participants receiving benefits2015-05-0118
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01266
2014: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01227
Total number of active participants reported on line 7a of the Form 55002014-05-01246
Number of retired or separated participants receiving benefits2014-05-0111
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01257
2013: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01220
Total number of active participants reported on line 7a of the Form 55002013-05-01227
Number of retired or separated participants receiving benefits2013-05-0112
Total of all active and inactive participants2013-05-01239
2012: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01207
Total number of active participants reported on line 7a of the Form 55002012-05-01220
Number of retired or separated participants receiving benefits2012-05-0110
Total of all active and inactive participants2012-05-01230
2011: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01194
Total number of active participants reported on line 7a of the Form 55002011-05-01207
Number of retired or separated participants receiving benefits2011-05-0110
Total of all active and inactive participants2011-05-01217
2009: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01195
Total number of active participants reported on line 7a of the Form 55002009-05-01186
Number of retired or separated participants receiving benefits2009-05-0113
Total of all active and inactive participants2009-05-01199

Form 5500 Responses for KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN

2017: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01This submission is the final filingYes
2017-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan funding arrangement – General assets of the sponsorYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – General assets of the sponsorYes
2016: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan funding arrangement – General assets of the sponsorYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – General assets of the sponsorYes
2015: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan funding arrangement – General assets of the sponsorYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – General assets of the sponsorYes
2014: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan funding arrangement – General assets of the sponsorYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – General assets of the sponsorYes
2013: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedYes
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan funding arrangement – General assets of the sponsorYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – General assets of the sponsorYes
2012: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan funding arrangement – General assets of the sponsorYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – General assets of the sponsorYes
2011: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan funding arrangement – General assets of the sponsorYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – General assets of the sponsorYes
2009: KRIZ DAVIS CO GROUP HEALTH & LIFE & DENTAL PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan funding arrangement – General assets of the sponsorYes
2009-05-01Plan benefit arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number22695
Policy instance 4
Insurance contract or identification number22695
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,842
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $548
Insurance broker nameFRANCES OSTERMEIER
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9081430358
Policy instance 3
Insurance contract or identification number9081430358
Insurance policy start date2017-07-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,357
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,901
Insurance broker organization code?3
Insurance broker namePREFERRED MARKETING ASSOCIATES
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF2955051
Policy instance 2
Insurance contract or identification numberF2955051
Insurance policy start date2017-09-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $906
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $906
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY INC
BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )
Policy contract number300010
Policy instance 1
Insurance contract or identification number300010
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $32,886
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,886
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberG7M62
Policy instance 4
Insurance contract or identification numberG7M62
Number of Individuals Covered65
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $12,670
Total amount of fees paid to insurance companyUSD $1,514
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,374
Amount paid for insurance broker fees401
Insurance broker organization code?3
Insurance broker nameJAY P HIGGINS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9081430358
Policy instance 3
Insurance contract or identification number9081430358
Number of Individuals Covered125
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $13,091
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,724
Insurance broker organization code?3
Insurance broker namePREFERRED MARKETING ASSOCIATES
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF2955051
Policy instance 2
Insurance contract or identification numberF2955051
Number of Individuals Covered248
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $2,350
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,350
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY INC
BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )
Policy contract number300010
Policy instance 1
Insurance contract or identification number300010
Number of Individuals Covered227
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $43,856
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,856
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9081430358
Policy instance 3
Insurance contract or identification number9081430358
Number of Individuals Covered109
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $11,048
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,365
Insurance broker organization code?3
Insurance broker namePREFERRED MARKETING ASSOCIATES
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberG7M62
Policy instance 4
Insurance contract or identification numberG7M62
Number of Individuals Covered52
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $13,297
Total amount of fees paid to insurance companyUSD $55
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,382
Amount paid for insurance broker fees54
Insurance broker organization code?3
Insurance broker nameJOHN D TYLER
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF2955051
Policy instance 2
Insurance contract or identification numberF2955051
Number of Individuals Covered246
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $2,273
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,273
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY INC
BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )
Policy contract number300010
Policy instance 1
Insurance contract or identification number300010
Number of Individuals Covered217
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $25,355
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,355
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9081430358
Policy instance 3
Insurance contract or identification number9081430358
Number of Individuals Covered139
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $9,524
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,349
Insurance broker organization code?3
Insurance broker namePREFERRED MARKETING ASSOCIATES
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF2955051
Policy instance 2
Insurance contract or identification numberF2955051
Number of Individuals Covered227
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $2,197
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,197
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY INC
BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )
Policy contract number300010
Policy instance 1
Insurance contract or identification number300010
Number of Individuals Covered206
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $24,546
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,546
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF2955051
Policy instance 2
Insurance contract or identification numberF2955051
Number of Individuals Covered220
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $1,794
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,794
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY INC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9081430358
Policy instance 3
Insurance contract or identification number9081430358
Number of Individuals Covered124
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $9,090
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,060
Insurance broker organization code?3
Insurance broker namePREFERRED MARKETING ASSOCIATES
BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )
Policy contract number300010
Policy instance 1
Insurance contract or identification number300010
Number of Individuals Covered186
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $19,910
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,910
Insurance broker organization code?3
Insurance broker nameKRULL AGENCY
BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )
Policy contract number300010
Policy instance 1
Insurance contract or identification number300010
Number of Individuals Covered187
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $19,786
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF2955051
Policy instance 2
Insurance contract or identification numberF2955051
Number of Individuals Covered207
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $1,640
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9081430358
Policy instance 3
Insurance contract or identification number9081430358
Number of Individuals Covered117
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $8,686
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF2955051
Policy instance 2
Insurance contract or identification numberF2955051
Number of Individuals Covered204
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $1,809
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF NEBRASKA (National Association of Insurance Commissioners NAIC id number: 77780 )
Policy contract number13360
Policy instance 1
Insurance contract or identification number13360
Number of Individuals Covered194
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $20,933
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9081430358
Policy instance 3
Insurance contract or identification number9081430358
Number of Individuals Covered115
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $8,201
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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