401k Plan data: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN plan

HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 401k Plan overview

Plan Name	HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN
Plan identification number	001

HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
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

HEARN INDUSTRIAL SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: HEARN INDUSTRIAL SERVICES, INC.

Employer identification number (EIN): 611776537

NAIC Classification: 488490
NAIC Description: Other Support Activities for Road Transportation

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2021-01-01
001 2020-01-01

Plan Statistics for HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN

401k plan membership statisitcs for HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN

Measure Date Value
2022: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 250
Number of retired or separated participants receiving benefits 2022-01-01 2
Number of other retired or separated participants entitled to future benefits 2022-01-01 10
Total of all active and inactive participants 2022-01-01 262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 262
Number of participants with account balances 2022-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 194
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 10
Total of all active and inactive participants 2021-01-01 204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 204
Number of participants with account balances 2021-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 2
2020: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 103
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 7
Total of all active and inactive participants 2020-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 111
Number of participants with account balances 2020-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 10

Measure	Date	Value
2022: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	250
Number of retired or separated participants receiving benefits	2022-01-01	2
Number of other retired or separated participants entitled to future benefits	2022-01-01	10
Total of all active and inactive participants	2022-01-01	262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	262
Number of participants with account balances	2022-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	194
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	10
Total of all active and inactive participants	2021-01-01	204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	204
Number of participants with account balances	2021-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	2
2020: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	103
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	7
Total of all active and inactive participants	2020-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	111
Number of participants with account balances	2020-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	10

Financial Data on HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN

Measure	Date	Value
2022 : HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$155
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$222
Total income from all sources (including contributions)	2022-12-31	$1,576
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$16,225
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$16,225
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$62,654
Value of total assets at end of year	2022-12-31	$275,898
Value of total assets at beginning of year	2022-12-31	$290,614
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$0
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$100,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$56,122
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$155
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$222
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-14,649
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$275,743
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$290,392
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$258,482
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$270,753
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$17,416
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$19,861
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-61,078
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$6,532
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$16,225
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	BAKER TILLY US, LLP
Accountancy firm EIN	2022-12-31	390859910
2021 : HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$222
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$278
Total income from all sources (including contributions)	2021-12-31	$93,496
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$3,452
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$56,211
Value of total assets at end of year	2021-12-31	$290,614
Value of total assets at beginning of year	2021-12-31	$200,626
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$3,452
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$100,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$6,160
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$253
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$222
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$278
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$90,044
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$290,392
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$200,348
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$270,753
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$186,207
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$19,861
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$14,419
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$37,285
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$49,798
Contract administrator fees	2021-12-31	$3,452
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	BAKER TILLY
Accountancy firm EIN	2021-12-31	390859910
2020 : HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$278
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$202,032
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,684
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,684
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$180,394
Value of total assets at end of year	2020-12-31	$200,626
Value of total assets at beginning of year	2020-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$0
Total interest from all sources	2020-12-31	$346
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$100,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$39,363
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$135,167
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$278
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$200,348
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$200,348
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$186,207
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$0
Interest earned on other investments	2020-12-31	$346
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$14,419
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$21,292
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$5,864
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$1,684
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	PLANTE MORAN
Accountancy firm EIN	2020-12-31	381357951

Form 5500 Responses for HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN

2022: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: HEARN INDUSTRIAL SERVICES, INC. EMPLOYEE 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

586-80057

Policy instance

Insurance contract or identification number	586-80057
Number of Individuals Covered	35
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $92
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $92
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

586-80057

Policy instance

Insurance contract or identification number	586-80057
Number of Individuals Covered	30
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $88
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

586-80057

Policy instance

Insurance contract or identification number	586-80057
Number of Individuals Covered	28
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $143
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $143
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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Company Name:	HEARN INDUSTRIAL SERVICES, INC.
Employer identification number (EIN):	611776537
NAIC Classification:	488490
NAIC Description:	Other Support Activities for Road Transportation