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AIRDYE SOLUTIONS, LLC 401(K) PLAN 401k Plan overview

Plan NameAIRDYE SOLUTIONS, LLC 401(K) PLAN
Plan identification number 001

AIRDYE SOLUTIONS, LLC 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • 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

AIRDYE SOLUTIONS, LLC has sponsored the creation of one or more 401k plans.

Company Name:AIRDYE SOLUTIONS, LLC
Employer identification number (EIN):611719847
NAIC Classification:323100

Additional information about AIRDYE SOLUTIONS, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 5382601

More information about AIRDYE SOLUTIONS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AIRDYE SOLUTIONS, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012016-01-01JOCELYN MENDEZ2016-08-29
0012015-01-01JOCELYN. MENDEZ2016-08-24
0012014-01-01MARK LYNCH
0012014-01-01MARK LYNCH
0012014-01-01MARK LYNCH
0012013-01-01BEVERLY A SMILEY

Plan Statistics for AIRDYE SOLUTIONS, LLC 401(K) PLAN

401k plan membership statisitcs for AIRDYE SOLUTIONS, LLC 401(K) PLAN

Measure Date Value
2014: AIRDYE SOLUTIONS, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01127
Total number of active participants reported on line 7a of the Form 55002014-01-0156
Number of retired or separated participants receiving benefits2014-01-011
Number of other retired or separated participants entitled to future benefits2014-01-0141
Total of all active and inactive participants2014-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0198
Number of participants with account balances2014-01-0198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-016
2013: AIRDYE SOLUTIONS, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01150
Total number of active participants reported on line 7a of the Form 55002013-01-0183
Number of retired or separated participants receiving benefits2013-01-0113
Number of other retired or separated participants entitled to future benefits2013-01-0129
Total of all active and inactive participants2013-01-01125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01125
Number of participants with account balances2013-01-01103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-012

Financial Data on AIRDYE SOLUTIONS, LLC 401(K) PLAN

Measure Date Value
2014 : AIRDYE SOLUTIONS, LLC 401(K) PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets2014-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$0
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Expenses. Interest paid2014-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022014-12-31$0
Total income from all sources (including contributions)2014-12-31$513,713
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$738,333
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$690,140
Expenses. Certain deemed distributions of participant loans2014-12-31$29,246
Value of total corrective distributions2014-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$142,984
Value of total assets at end of year2014-12-31$5,583,085
Value of total assets at beginning of year2014-12-31$5,807,705
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$18,947
Total income from rents2014-12-31$0
Total interest from all sources2014-12-31$9,463
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2014-12-31$0
Assets. Real estate other than employer real property at end of year2014-12-31$0
Assets. Real estate other than employer real property at beginning of year2014-12-31$0
Administrative expenses professional fees incurred2014-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2014-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2014-12-31$0
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$97,633
Participant contributions at end of year2014-12-31$152,798
Participant contributions at beginning of year2014-12-31$198,536
Participant contributions at end of year2014-12-31$0
Participant contributions at beginning of year2014-12-31$0
Assets. Other investments not covered elsewhere at end of year2014-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$45,351
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$0
Assets. Loans (other than to participants) at end of year2014-12-31$0
Assets. Loans (other than to participants) at beginning of year2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$0
Other income not declared elsewhere2014-12-31$361,266
Administrative expenses (other) incurred2014-12-31$10
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Income. Non cash contributions2014-12-31$0
Value of net income/loss2014-12-31$-224,620
Value of net assets at end of year (total assets less liabilities)2014-12-31$5,583,085
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$5,807,705
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Assets. partnership/joint venture interests at end of year2014-12-31$0
Assets. partnership/joint venture interests at beginning of year2014-12-31$0
Investment advisory and management fees2014-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$5,128,219
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$5,265,140
Interest on participant loans2014-12-31$5,109
Income. Interest from loans (other than to participants)2014-12-31$0
Interest earned on other investments2014-12-31$4,354
Income. Interest from US Government securities2014-12-31$0
Income. Interest from corporate debt instruments2014-12-31$0
Value of interest in master investment trust accounts at end of year2014-12-31$0
Value of interest in master investment trust accounts at beginning of year2014-12-31$0
Value of interest in common/collective trusts at end of year2014-12-31$0
Value of interest in common/collective trusts at beginning of year2014-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2014-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2014-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$302,068
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$344,029
Asset value of US Government securities at end of year2014-12-31$0
Asset value of US Government securities at beginning of year2014-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$0
Net investment gain/loss from pooled separate accounts2014-12-31$0
Net investment gain or loss from common/collective trusts2014-12-31$0
Net gain/loss from 103.12 investment entities2014-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Assets. Invements in employer securities at end of year2014-12-31$0
Assets. Invements in employer securities at beginning of year2014-12-31$0
Assets. Value of employer real property at end of year2014-12-31$0
Assets. Value of employer real property at beginning of year2014-12-31$0
Contributions received in cash from employer2014-12-31$0
Employer contributions (assets) at end of year2014-12-31$0
Employer contributions (assets) at beginning of year2014-12-31$0
Income. Dividends from preferred stock2014-12-31$0
Income. Dividends from common stock2014-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$690,140
Asset. Corporate debt instrument preferred debt at end of year2014-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2014-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2014-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2014-12-31$0
Contract administrator fees2014-12-31$18,937
Assets. Corporate common stocks other than exployer securities at end of year2014-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2014-12-31$0
Liabilities. Value of benefit claims payable at end of year2014-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2014-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-12-31$0
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$0
Aggregate carrying amount (costs) on sale of assets2014-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2014-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2014-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31BURDETTE SMITH & BISH, LLC
Accountancy firm EIN2014-12-31454037800
2013 : AIRDYE SOLUTIONS, LLC 401(K) PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets2013-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$0
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Expenses. Interest paid2013-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022013-12-31$0
Total income from all sources (including contributions)2013-12-31$1,091,114
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$2,189,800
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$2,070,171
Expenses. Certain deemed distributions of participant loans2013-12-31$98,398
Value of total corrective distributions2013-12-31$976
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$183,543
Value of total assets at end of year2013-12-31$5,807,705
Value of total assets at beginning of year2013-12-31$6,906,391
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$20,255
Total income from rents2013-12-31$0
Total interest from all sources2013-12-31$10,373
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$234,610
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$234,610
Assets. Real estate other than employer real property at end of year2013-12-31$0
Assets. Real estate other than employer real property at beginning of year2013-12-31$0
Administrative expenses professional fees incurred2013-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2013-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2013-12-31$0
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$98,543
Participant contributions at end of year2013-12-31$198,536
Participant contributions at beginning of year2013-12-31$303,123
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$0
Assets. Other investments not covered elsewhere at end of year2013-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$85,000
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$0
Assets. Loans (other than to participants) at end of year2013-12-31$0
Assets. Loans (other than to participants) at beginning of year2013-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$0
Other income not declared elsewhere2013-12-31$16,046
Administrative expenses (other) incurred2013-12-31$0
Total non interest bearing cash at end of year2013-12-31$0
Total non interest bearing cash at beginning of year2013-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Income. Non cash contributions2013-12-31$0
Value of net income/loss2013-12-31$-1,098,686
Value of net assets at end of year (total assets less liabilities)2013-12-31$5,807,705
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$6,906,391
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Assets. partnership/joint venture interests at end of year2013-12-31$0
Assets. partnership/joint venture interests at beginning of year2013-12-31$0
Investment advisory and management fees2013-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$5,265,140
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$6,306,198
Interest on participant loans2013-12-31$5,785
Income. Interest from loans (other than to participants)2013-12-31$0
Interest earned on other investments2013-12-31$4,588
Income. Interest from US Government securities2013-12-31$0
Income. Interest from corporate debt instruments2013-12-31$0
Value of interest in master investment trust accounts at end of year2013-12-31$0
Value of interest in master investment trust accounts at beginning of year2013-12-31$0
Value of interest in common/collective trusts at end of year2013-12-31$0
Value of interest in common/collective trusts at beginning of year2013-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2013-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2013-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$344,029
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$297,070
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$0
Asset value of US Government securities at end of year2013-12-31$0
Asset value of US Government securities at beginning of year2013-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$646,542
Net investment gain/loss from pooled separate accounts2013-12-31$0
Net investment gain or loss from common/collective trusts2013-12-31$0
Net gain/loss from 103.12 investment entities2013-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31Yes
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Assets. Invements in employer securities at end of year2013-12-31$0
Assets. Invements in employer securities at beginning of year2013-12-31$0
Assets. Value of employer real property at end of year2013-12-31$0
Assets. Value of employer real property at beginning of year2013-12-31$0
Employer contributions (assets) at end of year2013-12-31$0
Employer contributions (assets) at beginning of year2013-12-31$0
Income. Dividends from preferred stock2013-12-31$0
Income. Dividends from common stock2013-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$2,070,171
Asset. Corporate debt instrument preferred debt at end of year2013-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2013-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2013-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2013-12-31$0
Contract administrator fees2013-12-31$20,255
Assets. Corporate common stocks other than exployer securities at end of year2013-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2013-12-31$0
Liabilities. Value of benefit claims payable at end of year2013-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2013-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-12-31$0
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$0
Aggregate carrying amount (costs) on sale of assets2013-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2013-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2013-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31BURDETTE SMITH & BISH, LLC
Accountancy firm EIN2013-12-31454037800

Form 5500 Responses for AIRDYE SOLUTIONS, LLC 401(K) PLAN

2014: AIRDYE SOLUTIONS, LLC 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: AIRDYE SOLUTIONS, LLC 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number331610-01
Policy instance 1
Insurance contract or identification number331610-01
Number of Individuals Covered29
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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?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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number331610-01
Policy instance 1
Insurance contract or identification number331610-01
Number of Individuals Covered35
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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?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

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