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KATERRA INC 401 (K) PLAN 401k Plan overview

Plan NameKATERRA INC 401 (K) PLAN
Plan identification number 001

KATERRA INC 401 (K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

KATERRA, INC. has sponsored the creation of one or more 401k plans.

Company Name:KATERRA, INC.
Employer identification number (EIN):472918559
NAIC Classification:541310
NAIC Description:Architectural Services

Additional information about KATERRA, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2017-01-05
Company Identification Number: 0802618817
Legal Registered Office Address: 3101 N CENTRAL AVE STE 670

PHOENIX
United States of America (USA)
85012

More information about KATERRA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KATERRA INC 401 (K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-01-01
0012018-01-01
0012018-01-01
0012018-01-01
0012017-01-01STEPHANIE HEINE
0012017-01-01STEPHANIE HEINE

Plan Statistics for KATERRA INC 401 (K) PLAN

401k plan membership statisitcs for KATERRA INC 401 (K) PLAN

Measure Date Value
2019: KATERRA INC 401 (K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-012,926
Total number of active participants reported on line 7a of the Form 55002019-01-013,182
Number of retired or separated participants receiving benefits2019-01-013
Number of other retired or separated participants entitled to future benefits2019-01-01945
Total of all active and inactive participants2019-01-014,130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-013
Total participants2019-01-014,133
Number of participants with account balances2019-01-013,607
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: KATERRA INC 401 (K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,136
Total number of active participants reported on line 7a of the Form 55002018-01-012,608
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-01316
Total of all active and inactive participants2018-01-012,924
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-012
Total participants2018-01-012,926
Number of participants with account balances2018-01-012,547
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: KATERRA INC 401 (K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01609
Total number of active participants reported on line 7a of the Form 55002017-01-01939
Number of retired or separated participants receiving benefits2017-01-0188
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-011,027
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-011,027
Number of participants with account balances2017-01-01835
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010

Financial Data on KATERRA INC 401 (K) PLAN

Measure Date Value
2019 : KATERRA INC 401 (K) PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets2019-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets to this plan2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Expenses. Interest paid2019-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022019-12-31$0
Total income from all sources (including contributions)2019-12-31$55,981,526
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$7,457,737
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$7,388,377
Expenses. Certain deemed distributions of participant loans2019-12-31$22,610
Value of total corrective distributions2019-12-31$3,142
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$44,640,581
Value of total assets at end of year2019-12-31$81,329,760
Value of total assets at beginning of year2019-12-31$32,805,971
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$43,608
Total income from rents2019-12-31$0
Total interest from all sources2019-12-31$45,083
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$563,656
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$563,656
Assets. Real estate other than employer real property at end of year2019-12-31$0
Assets. Real estate other than employer real property at beginning of year2019-12-31$0
Administrative expenses professional fees incurred2019-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2019-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$19,549,489
Participant contributions at end of year2019-12-31$1,282,267
Participant contributions at beginning of year2019-12-31$479,888
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Assets. Other investments not covered elsewhere at end of year2019-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$15,205,972
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Assets. Loans (other than to participants) at end of year2019-12-31$0
Assets. Loans (other than to participants) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$178,038
Administrative expenses (other) incurred2019-12-31$42,582
Liabilities. Value of operating payables at end of year2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$0
Total non interest bearing cash at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Income. Non cash contributions2019-12-31$0
Value of net income/loss2019-12-31$48,523,789
Value of net assets at end of year (total assets less liabilities)2019-12-31$81,329,760
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$32,805,971
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Assets. partnership/joint venture interests at end of year2019-12-31$0
Assets. partnership/joint venture interests at beginning of year2019-12-31$0
Investment advisory and management fees2019-12-31$1,026
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$24,233,513
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$31,236,905
Value of interest in pooled separate accounts at end of year2019-12-31$0
Value of interest in pooled separate accounts at beginning of year2019-12-31$0
Interest on participant loans2019-12-31$41,433
Income. Interest from loans (other than to participants)2019-12-31$0
Interest earned on other investments2019-12-31$3,650
Income. Interest from US Government securities2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
Value of interest in master investment trust accounts at end of year2019-12-31$0
Value of interest in master investment trust accounts at beginning of year2019-12-31$0
Value of interest in common/collective trusts at end of year2019-12-31$55,277,173
Value of interest in common/collective trusts at beginning of year2019-12-31$1,083,781
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$5,397
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$5,397
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2019-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$536,807
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Asset value of US Government securities at end of year2019-12-31$0
Asset value of US Government securities at beginning of year2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$4,765,923
Net investment gain/loss from pooled separate accounts2019-12-31$0
Net investment gain or loss from common/collective trusts2019-12-31$5,788,245
Net gain/loss from 103.12 investment entities2019-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Assets. Invements in employer securities at end of year2019-12-31$0
Assets. Invements in employer securities at beginning of year2019-12-31$0
Assets. Value of employer real property at end of year2019-12-31$0
Assets. Value of employer real property at beginning of year2019-12-31$0
Contributions received in cash from employer2019-12-31$9,885,120
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Income. Dividends from preferred stock2019-12-31$0
Income. Dividends from common stock2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$7,388,377
Asset. Corporate debt instrument preferred debt at end of year2019-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2019-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2019-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2019-12-31$0
Contract administrator fees2019-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
Assets. Corporate common stocks other than exployer securities at end of year2019-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$0
Liabilities. Value of benefit claims payable at end of year2019-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2019-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2019-12-31$0
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Aggregate proceeds on sale of assets2019-12-31$0
Aggregate carrying amount (costs) on sale of assets2019-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2019-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2019-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31ARMANINO LLP
Accountancy firm EIN2019-12-31946214841
2018 : KATERRA INC 401 (K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total transfer of assets to this plan2018-12-31$113,138
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$25,504,684
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,362,153
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,316,301
Value of total corrective distributions2018-12-31$37,052
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$27,981,096
Value of total assets at end of year2018-12-31$32,805,971
Value of total assets at beginning of year2018-12-31$8,550,302
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$8,800
Total interest from all sources2018-12-31$10,028
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$1,549,421
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$1,549,421
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$9,918,160
Participant contributions at end of year2018-12-31$479,888
Participant contributions at beginning of year2018-12-31$90,413
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$13,062,267
Administrative expenses (other) incurred2018-12-31$8,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$24,142,531
Value of net assets at end of year (total assets less liabilities)2018-12-31$32,805,971
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$8,550,302
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$31,236,905
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$8,383,580
Interest on participant loans2018-12-31$9,788
Value of interest in common/collective trusts at end of year2018-12-31$1,083,781
Value of interest in common/collective trusts at beginning of year2018-12-31$74,041
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$5,397
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$2,268
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$2,268
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$240
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-4,045,034
Net investment gain or loss from common/collective trusts2018-12-31$9,173
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$5,000,669
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,316,301
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31ARMANINO LLP
Accountancy firm EIN2018-12-31946214841
2017 : KATERRA INC 401 (K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total transfer of assets to this plan2017-12-31$1,700,006
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$7,080,163
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$229,867
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$205,946
Value of total corrective distributions2017-12-31$20,177
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$6,523,414
Value of total assets at end of year2017-12-31$8,550,302
Value of total assets at beginning of year2017-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$3,744
Total interest from all sources2017-12-31$4,497
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$265,880
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$265,880
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$3,272,584
Participant contributions at end of year2017-12-31$90,413
Participant contributions at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$1,670,584
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$6,850,296
Value of net assets at end of year (total assets less liabilities)2017-12-31$8,550,302
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$3,744
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$8,383,580
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$0
Interest on participant loans2017-12-31$2,229
Value of interest in common/collective trusts at end of year2017-12-31$74,041
Value of interest in common/collective trusts at beginning of year2017-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$2,268
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$2,268
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$286,372
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,580,246
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$205,946
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31ARMANINO LLP
Accountancy firm EIN2017-12-31946214841

Form 5500 Responses for KATERRA INC 401 (K) PLAN

2019: KATERRA INC 401 (K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: KATERRA INC 401 (K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: KATERRA INC 401 (K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number64216
Policy instance 1
Insurance contract or identification number64216
Number of Individuals Covered78
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0

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