BTL INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BTL/LMR EMPLOYEE BENEFIT PLAN TRUST
| Measure | Date | Value |
|---|
| 2018 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $27,499 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $127,970 |
| Total income from all sources (including contributions) | 2018-05-31 | $873,114 |
| Total of all expenses incurred | 2018-05-31 | $1,059,143 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-05-31 | $899,648 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-05-31 | $860,155 |
| Value of total assets at end of year | 2018-05-31 | $597,208 |
| Value of total assets at beginning of year | 2018-05-31 | $883,708 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-05-31 | $159,495 |
| Total interest from all sources | 2018-05-31 | $548 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-05-31 | $3,523 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-05-31 | $3,523 |
| Administrative expenses professional fees incurred | 2018-05-31 | $159,495 |
| Was this plan covered by a fidelity bond | 2018-05-31 | Yes |
| Value of fidelity bond cover | 2018-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2018-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-05-31 | No |
| Contributions received from participants | 2018-05-31 | $268,905 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-05-31 | $8,778 |
| Total non interest bearing cash at end of year | 2018-05-31 | $597,208 |
| Total non interest bearing cash at beginning of year | 2018-05-31 | $424,005 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Value of net income/loss | 2018-05-31 | $-186,029 |
| Value of net assets at end of year (total assets less liabilities) | 2018-05-31 | $569,709 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-05-31 | $755,738 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-05-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-05-31 | $459,703 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-05-31 | $548 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-05-31 | $255,427 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-05-31 | $8,888 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-05-31 | No |
| Contributions received in cash from employer | 2018-05-31 | $591,250 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-05-31 | $644,221 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-05-31 | $27,499 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-05-31 | $119,192 |
| Did the plan have assets held for investment | 2018-05-31 | No |
| 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 | 2018-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-05-31 | Unqualified |
| Accountancy firm name | 2018-05-31 | BLACKBURN, CHILDERS & STEAGALL, PLC |
| Accountancy firm EIN | 2018-05-31 | 620647474 |
| 2017 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $127,970 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $273,104 |
| Total income from all sources (including contributions) | 2017-05-31 | $1,771,873 |
| Total of all expenses incurred | 2017-05-31 | $1,755,032 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-05-31 | $1,589,607 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-05-31 | $1,720,104 |
| Value of total assets at end of year | 2017-05-31 | $883,708 |
| Value of total assets at beginning of year | 2017-05-31 | $1,012,001 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-05-31 | $165,425 |
| Total interest from all sources | 2017-05-31 | $1,145 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-05-31 | $14,314 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-05-31 | $14,314 |
| Administrative expenses professional fees incurred | 2017-05-31 | $165,425 |
| Was this plan covered by a fidelity bond | 2017-05-31 | Yes |
| Value of fidelity bond cover | 2017-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-05-31 | No |
| Contributions received from participants | 2017-05-31 | $390,077 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-05-31 | $26,316 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-05-31 | $8,778 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-05-31 | $10,000 |
| Total non interest bearing cash at end of year | 2017-05-31 | $424,005 |
| Total non interest bearing cash at beginning of year | 2017-05-31 | $274,608 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Value of net income/loss | 2017-05-31 | $16,841 |
| Value of net assets at end of year (total assets less liabilities) | 2017-05-31 | $755,738 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-05-31 | $738,897 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-05-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-05-31 | $459,703 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-05-31 | $711,077 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-05-31 | $1,145 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-05-31 | $170,953 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-05-31 | $36,310 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-05-31 | No |
| Contributions received in cash from employer | 2017-05-31 | $1,330,027 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-05-31 | $1,418,654 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2017-05-31 | $119,192 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-05-31 | $263,104 |
| Did the plan have assets held for investment | 2017-05-31 | 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 | 2017-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-05-31 | Unqualified |
| Accountancy firm name | 2017-05-31 | BLACKBURN, CHILDERS & STEAGALL, PLC |
| Accountancy firm EIN | 2017-05-31 | 620647474 |
| 2016 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $273,104 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $193,179 |
| Total income from all sources (including contributions) | 2016-05-31 | $1,929,333 |
| Total of all expenses incurred | 2016-05-31 | $2,004,223 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-05-31 | $1,841,894 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-05-31 | $1,916,540 |
| Value of total assets at end of year | 2016-05-31 | $1,012,001 |
| Value of total assets at beginning of year | 2016-05-31 | $1,006,966 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-05-31 | $162,329 |
| Total interest from all sources | 2016-05-31 | $1,124 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-05-31 | $18,454 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-05-31 | $18,454 |
| Administrative expenses professional fees incurred | 2016-05-31 | $162,329 |
| Was this plan covered by a fidelity bond | 2016-05-31 | Yes |
| Value of fidelity bond cover | 2016-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-05-31 | No |
| Contributions received from participants | 2016-05-31 | $395,019 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-05-31 | $26,316 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-05-31 | $36,853 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-05-31 | $10,000 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-05-31 | $69,323 |
| Total non interest bearing cash at end of year | 2016-05-31 | $274,608 |
| Total non interest bearing cash at beginning of year | 2016-05-31 | $262,013 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Value of net income/loss | 2016-05-31 | $-74,890 |
| Value of net assets at end of year (total assets less liabilities) | 2016-05-31 | $738,897 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-05-31 | $813,787 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-05-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-05-31 | $711,077 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-05-31 | $708,100 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-05-31 | $1,124 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-05-31 | $179,535 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-05-31 | $-6,785 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-05-31 | No |
| Contributions received in cash from employer | 2016-05-31 | $1,521,521 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-05-31 | $1,662,359 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-05-31 | $263,104 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-05-31 | $123,856 |
| Did the plan have assets held for investment | 2016-05-31 | 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 | 2016-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-05-31 | Unqualified |
| Accountancy firm name | 2016-05-31 | BLACKBURN, CHILDERS & STEAGALL, PLC |
| Accountancy firm EIN | 2016-05-31 | 620647474 |
| 2015 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $193,179 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $164,949 |
| Total income from all sources (including contributions) | 2015-05-31 | $1,904,640 |
| Total of all expenses incurred | 2015-05-31 | $1,793,920 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-05-31 | $1,640,425 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-05-31 | $1,888,205 |
| Value of total assets at end of year | 2015-05-31 | $1,006,966 |
| Value of total assets at beginning of year | 2015-05-31 | $868,016 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-05-31 | $153,495 |
| Total interest from all sources | 2015-05-31 | $1,025 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-05-31 | $18,879 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-05-31 | $18,879 |
| Administrative expenses professional fees incurred | 2015-05-31 | $153,495 |
| Was this plan covered by a fidelity bond | 2015-05-31 | Yes |
| Value of fidelity bond cover | 2015-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
| Contributions received from participants | 2015-05-31 | $376,225 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-05-31 | $36,853 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-05-31 | $80,620 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-05-31 | $69,323 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-05-31 | $62,755 |
| Total non interest bearing cash at end of year | 2015-05-31 | $262,013 |
| Total non interest bearing cash at beginning of year | 2015-05-31 | $294,706 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Value of net income/loss | 2015-05-31 | $110,720 |
| Value of net assets at end of year (total assets less liabilities) | 2015-05-31 | $813,787 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-05-31 | $703,067 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-05-31 | $708,100 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-05-31 | $492,690 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-05-31 | $1,025 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-05-31 | $159,375 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-05-31 | $-3,469 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
| Contributions received in cash from employer | 2015-05-31 | $1,511,980 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-05-31 | $1,481,050 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2015-05-31 | $123,856 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-05-31 | $102,194 |
| Did the plan have assets held for investment | 2015-05-31 | 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 | 2015-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-05-31 | Unqualified |
| Accountancy firm name | 2015-05-31 | BLACKBURN, CHILDERS & STEAGALL, PLC |
| Accountancy firm EIN | 2015-05-31 | 620647474 |
| 2014 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $164,949 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $119,300 |
| Total income from all sources (including contributions) | 2014-05-31 | $1,976,540 |
| Total loss/gain on sale of assets | 2014-05-31 | $0 |
| Total of all expenses incurred | 2014-05-31 | $1,799,409 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-05-31 | $1,663,069 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-05-31 | $1,941,511 |
| Value of total assets at end of year | 2014-05-31 | $868,016 |
| Value of total assets at beginning of year | 2014-05-31 | $645,236 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-05-31 | $136,340 |
| Total interest from all sources | 2014-05-31 | $35,029 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-05-31 | No |
| Administrative expenses professional fees incurred | 2014-05-31 | $136,340 |
| Was this plan covered by a fidelity bond | 2014-05-31 | Yes |
| Value of fidelity bond cover | 2014-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-05-31 | No |
| Contributions received from participants | 2014-05-31 | $370,660 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-05-31 | $80,620 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-05-31 | $9,221 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-05-31 | $62,755 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-05-31 | $50,139 |
| Total non interest bearing cash at end of year | 2014-05-31 | $294,706 |
| Total non interest bearing cash at beginning of year | 2014-05-31 | $636,015 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Value of net income/loss | 2014-05-31 | $177,131 |
| Value of net assets at end of year (total assets less liabilities) | 2014-05-31 | $703,067 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-05-31 | $525,936 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-05-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-05-31 | $492,690 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-05-31 | $35,029 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-05-31 | $146,909 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-05-31 | No |
| Contributions received in cash from employer | 2014-05-31 | $1,570,851 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-05-31 | $1,516,160 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-05-31 | $102,194 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-05-31 | $69,161 |
| Did the plan have assets held for investment | 2014-05-31 | 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 | 2014-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-05-31 | Unqualified |
| Accountancy firm name | 2014-05-31 | RODEFER MOSS & CO, PLLC |
| Accountancy firm EIN | 2014-05-31 | 621690032 |
| 2013 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $119,300 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $153,553 |
| Total income from all sources (including contributions) | 2013-05-31 | $2,036,287 |
| Total loss/gain on sale of assets | 2013-05-31 | $0 |
| Total of all expenses incurred | 2013-05-31 | $1,521,864 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-05-31 | $1,396,153 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-05-31 | $2,034,355 |
| Value of total assets at end of year | 2013-05-31 | $645,236 |
| Value of total assets at beginning of year | 2013-05-31 | $165,066 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-05-31 | $125,711 |
| Total interest from all sources | 2013-05-31 | $1,932 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-05-31 | No |
| Was this plan covered by a fidelity bond | 2013-05-31 | Yes |
| Value of fidelity bond cover | 2013-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-05-31 | No |
| Contributions received from participants | 2013-05-31 | $365,367 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-05-31 | $9,221 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-05-31 | $104,236 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-05-31 | $50,139 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-05-31 | $50,139 |
| Total non interest bearing cash at end of year | 2013-05-31 | $636,015 |
| Total non interest bearing cash at beginning of year | 2013-05-31 | $60,830 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Value of net income/loss | 2013-05-31 | $514,423 |
| Value of net assets at end of year (total assets less liabilities) | 2013-05-31 | $525,936 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-05-31 | $11,513 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-05-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-05-31 | $1,932 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-05-31 | $145,683 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-05-31 | No |
| Contributions received in cash from employer | 2013-05-31 | $1,668,988 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-05-31 | $1,250,470 |
| Contract administrator fees | 2013-05-31 | $125,711 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-05-31 | $69,161 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-05-31 | $103,414 |
| Did the plan have assets held for investment | 2013-05-31 | No |
| 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 | 2013-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-05-31 | Unqualified |
| Accountancy firm name | 2013-05-31 | RODEFER MOSS & CO, PLLC |
| Accountancy firm EIN | 2013-05-31 | 621690032 |
| 2012 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2012 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2012-05-31 | $-5,216 |
| Total unrealized appreciation/depreciation of assets | 2012-05-31 | $-5,216 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $153,553 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $133,018 |
| Total income from all sources (including contributions) | 2012-05-31 | $1,916,430 |
| Total of all expenses incurred | 2012-05-31 | $1,932,779 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-05-31 | $1,821,096 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-05-31 | $1,921,367 |
| Value of total assets at end of year | 2012-05-31 | $165,066 |
| Value of total assets at beginning of year | 2012-05-31 | $160,880 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-05-31 | $111,683 |
| Total interest from all sources | 2012-05-31 | $279 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-05-31 | No |
| Administrative expenses professional fees incurred | 2012-05-31 | $6,550 |
| Was this plan covered by a fidelity bond | 2012-05-31 | Yes |
| Value of fidelity bond cover | 2012-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-05-31 | No |
| Contributions received from participants | 2012-05-31 | $305,951 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-05-31 | $104,236 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-05-31 | $5,559 |
| Total non interest bearing cash at end of year | 2012-05-31 | $1,000 |
| Total non interest bearing cash at beginning of year | 2012-05-31 | $1,000 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Value of net income/loss | 2012-05-31 | $-16,349 |
| Value of net assets at end of year (total assets less liabilities) | 2012-05-31 | $11,513 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-05-31 | $27,862 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-05-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-05-31 | $94,184 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-05-31 | $59,830 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-05-31 | $60,137 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-05-31 | $60,137 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-05-31 | $279 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-05-31 | $147,617 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-05-31 | No |
| Contributions received in cash from employer | 2012-05-31 | $1,615,416 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-05-31 | $1,673,479 |
| Contract administrator fees | 2012-05-31 | $105,133 |
| Liabilities. Value of benefit claims payable at end of year | 2012-05-31 | $153,553 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-05-31 | $133,018 |
| Did the plan have assets held for investment | 2012-05-31 | No |
| 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 | 2012-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-05-31 | Unqualified |
| Accountancy firm name | 2012-05-31 | RODEFER MOSS & CO, PLLC |
| Accountancy firm EIN | 2012-05-31 | 621690032 |
| 2011 : BTL/LMR EMPLOYEE BENEFIT PLAN TRUST 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-05-31 | $17,859 |
| Total unrealized appreciation/depreciation of assets | 2011-05-31 | $17,859 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $133,018 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $70,607 |
| Total income from all sources (including contributions) | 2011-05-31 | $1,780,299 |
| Total of all expenses incurred | 2011-05-31 | $1,913,989 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-05-31 | $1,801,590 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-05-31 | $1,762,143 |
| Value of total assets at end of year | 2011-05-31 | $160,880 |
| Value of total assets at beginning of year | 2011-05-31 | $232,159 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-05-31 | $112,399 |
| Total interest from all sources | 2011-05-31 | $297 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-05-31 | No |
| Administrative expenses professional fees incurred | 2011-05-31 | $6,300 |
| Was this plan covered by a fidelity bond | 2011-05-31 | Yes |
| Value of fidelity bond cover | 2011-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-05-31 | No |
| Contributions received from participants | 2011-05-31 | $273,756 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-05-31 | $2,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-05-31 | $5,559 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-05-31 | $8,998 |
| Total non interest bearing cash at end of year | 2011-05-31 | $1,000 |
| Total non interest bearing cash at beginning of year | 2011-05-31 | $1,000 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Value of net income/loss | 2011-05-31 | $-133,690 |
| Value of net assets at end of year (total assets less liabilities) | 2011-05-31 | $27,862 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-05-31 | $161,552 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-05-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-05-31 | $94,184 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-05-31 | $176,325 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-05-31 | $60,137 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-05-31 | $45,836 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-05-31 | $45,836 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-05-31 | $297 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-05-31 | $129,926 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-05-31 | No |
| Contributions received in cash from employer | 2011-05-31 | $1,488,387 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-05-31 | $1,669,664 |
| Contract administrator fees | 2011-05-31 | $106,099 |
| Liabilities. Value of benefit claims payable at end of year | 2011-05-31 | $133,018 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-05-31 | $70,607 |
| Did the plan have assets held for investment | 2011-05-31 | 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 | 2011-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-05-31 | Unqualified |
| Accountancy firm name | 2011-05-31 | RODEFER MOSS & CO, PLLC |
| Accountancy firm EIN | 2011-05-31 | 621690032 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 932823 |
| Policy instance | 3 |
| Insurance contract or identification number | 932823 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $350,361 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $75,426 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B2JW |
| Policy instance | 1 |
| Insurance contract or identification number | G000B2JW | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,411 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $54,811 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3411 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 932823 |
| Policy instance | 3 |
| Insurance contract or identification number | 932823 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $278,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,944 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,138,623 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2944 | | Additional information about fees paid to insurance broker | CONSULTANT/BROKER FEE | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B2JW |
| Policy instance | 1 |
| Insurance contract or identification number | G000B2JW | | Number of Individuals Covered | 100 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,550 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $56,851 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2550 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B2JW |
| Policy instance | 1 |
| Insurance contract or identification number | G000B2JW | | Number of Individuals Covered | 270 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $33,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,500 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $748,080 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2500 | | Additional information about fees paid to insurance broker | CONSULTANT / BROKER FEE | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 932823 |
| Policy instance | 3 |
| Insurance contract or identification number | 932823 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $149,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B2JW |
| Policy instance | 1 |
| Insurance contract or identification number | G000B2JW | | Number of Individuals Covered | 280 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-06-01 | | Total amount of commissions paid to insurance broker | USD $3,598 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $57,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,598 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 3 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $10,000 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $176,276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,000 | | Additional information about fees paid to insurance broker | CONSULTANT/BROKER | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $2,923 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,923 | | Additional information about fees paid to insurance broker | CONSULTANT/BROKER | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 4 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $10,000 | | Welfare Benefit Premiums Paid to Carrier | USD $215,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 3 |
| Insurance contract or identification number | 122094 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $28 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $2,984 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,614 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B2JW |
| Policy instance | 1 |
| Insurance contract or identification number | G000B2JW | | Number of Individuals Covered | 278 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-06-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,457 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $75,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 417648 |
| Policy instance | 1 |
| Insurance contract or identification number | 417648 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-06-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $8,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | BLAKELY, WILLIAM R |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $4,040 | | Total amount of fees paid to insurance company | USD $5,960 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $169,882 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,040 | | Amount paid for insurance broker fees | 5960 | | Additional information about fees paid to insurance broker | CONSULTING FEE | | Insurance broker organization code? | 3 | | Insurance broker name | COLES, WILLIAM |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 362 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $5,761 | | Total amount of fees paid to insurance company | USD $4,239 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $153,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,761 | | Amount paid for insurance broker fees | 4239 | | Additional information about fees paid to insurance broker | CONSULTING FEE | | Insurance broker organization code? | 3 | | Insurance broker name | W P COLES |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000417648 |
| Policy instance | 1 |
| Insurance contract or identification number | 000000417648 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-06-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,392 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | WELLS FARGO INS SVCS USA, INC |
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| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 354 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $6,000 | | Total amount of fees paid to insurance company | USD $2,500 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $136,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,000 | | Amount paid for insurance broker fees | 2500 | | Additional information about fees paid to insurance broker | FEE | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM COLES |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL149854 |
| Policy instance | 1 |
| Insurance contract or identification number | GL149854 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $1,493 | | Total amount of fees paid to insurance company | USD $423 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,687 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,353 | | Amount paid for insurance broker fees | 423 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
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| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 122094 |
| Policy instance | 2 |
| Insurance contract or identification number | 122094 | | Number of Individuals Covered | 350 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $13,427 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $142,709 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,350 | | Insurance broker organization code? | 3 | | Insurance broker name | MICHAEL FOX |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL149854 |
| Policy instance | 1 |
| Insurance contract or identification number | GL149854 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $1,277 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,771 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,172 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010091176 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010091176 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $1,627 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010091176 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010091176 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $1,628 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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