DELTA INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN
401k plan membership statisitcs for JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2015 : JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-03-31 | $68,993 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-03-31 | $41,733 |
| Total income from all sources (including contributions) | 2015-03-31 | $464,232 |
| Total of all expenses incurred | 2015-03-31 | $491,740 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-03-31 | $470,729 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-03-31 | $464,230 |
| Value of total assets at end of year | 2015-03-31 | $42,044 |
| Value of total assets at beginning of year | 2015-03-31 | $42,292 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-03-31 | $21,011 |
| Total interest from all sources | 2015-03-31 | $2 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-03-31 | No |
| Was this plan covered by a fidelity bond | 2015-03-31 | Yes |
| Value of fidelity bond cover | 2015-03-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-03-31 | No |
| Contributions received from participants | 2015-03-31 | $82,499 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2015-03-31 | $46,375 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-03-31 | $68,993 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-03-31 | $41,733 |
| Total non interest bearing cash at end of year | 2015-03-31 | $42,044 |
| Total non interest bearing cash at beginning of year | 2015-03-31 | $42,292 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-03-31 | No |
| Value of net income/loss | 2015-03-31 | $-27,508 |
| Value of net assets at end of year (total assets less liabilities) | 2015-03-31 | $-26,949 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-03-31 | $559 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-03-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-03-31 | $2 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-03-31 | $81,448 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-03-31 | No |
| Contributions received in cash from employer | 2015-03-31 | $335,356 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-03-31 | $389,281 |
| Contract administrator fees | 2015-03-31 | $21,011 |
| Did the plan have assets held for investment | 2015-03-31 | 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 | 2015-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-03-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-03-31 | Disclaimer |
| Accountancy firm name | 2015-03-31 | BKD, LLP |
| Accountancy firm EIN | 2015-03-31 | 440160260 |
| 2014 : JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $41,733 |
| Total income from all sources (including contributions) | 2014-12-31 | $2,134,430 |
| Total of all expenses incurred | 2014-12-31 | $2,192,770 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $2,072,208 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $2,134,425 |
| Value of total assets at end of year | 2014-12-31 | $42,292 |
| Value of total assets at beginning of year | 2014-12-31 | $58,899 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $120,562 |
| Total interest from all sources | 2014-12-31 | $5 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $305,906 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2014-12-31 | $281,627 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $41,733 |
| Total non interest bearing cash at end of year | 2014-12-31 | $42,292 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $58,899 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-58,340 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $559 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $58,899 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $5 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $360,164 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $1,546,892 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $1,712,044 |
| Contract administrator fees | 2014-12-31 | $120,562 |
| Did the plan have assets held for investment | 2014-12-31 | 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 | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
| Accountancy firm name | 2014-12-31 | BKD, LLP |
| Accountancy firm EIN | 2014-12-31 | 440160260 |
| 2013 : JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-12-31 | $2,414,290 |
| Total of all expenses incurred | 2013-12-31 | $2,360,051 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $2,262,905 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $2,414,290 |
| Value of total assets at end of year | 2013-12-31 | $58,899 |
| Value of total assets at beginning of year | 2013-12-31 | $4,660 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $97,146 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $314,292 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-12-31 | $380,621 |
| Total non interest bearing cash at end of year | 2013-12-31 | $58,899 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $4,660 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $54,239 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $58,899 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $4,660 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $282,013 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $1,719,377 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $1,980,892 |
| Contract administrator fees | 2013-12-31 | $97,146 |
| Did the plan have assets held for investment | 2013-12-31 | 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 | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Disclaimer |
| Accountancy firm name | 2013-12-31 | BKD, LLP |
| Accountancy firm EIN | 2013-12-31 | 440160260 |
| 2012 : JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-12-31 | $1,762,232 |
| Total of all expenses incurred | 2012-12-31 | $1,776,418 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $1,674,116 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $1,762,223 |
| Value of total assets at end of year | 2012-12-31 | $4,660 |
| Value of total assets at beginning of year | 2012-12-31 | $18,846 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $102,302 |
| Total interest from all sources | 2012-12-31 | $9 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $345,458 |
| Total non interest bearing cash at end of year | 2012-12-31 | $4,660 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $18,846 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-14,186 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $4,660 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $18,846 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $9 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $304,498 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $1,416,765 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $1,369,618 |
| Contract administrator fees | 2012-12-31 | $102,302 |
| Did the plan have assets held for investment | 2012-12-31 | 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 | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Disclaimer |
| Accountancy firm name | 2012-12-31 | BKD, LLP |
| Accountancy firm EIN | 2012-12-31 | 440160260 |
| 2011 : JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-12-31 | $1,543,513 |
| Total of all expenses incurred | 2011-12-31 | $1,526,845 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $1,426,312 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $1,543,469 |
| Value of total assets at end of year | 2011-12-31 | $18,846 |
| Value of total assets at beginning of year | 2011-12-31 | $2,178 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $100,533 |
| Total interest from all sources | 2011-12-31 | $44 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Was this plan covered by a fidelity bond | 2011-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $322,693 |
| Total non interest bearing cash at end of year | 2011-12-31 | $18,846 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $2,178 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $16,668 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $18,846 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $2,178 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $44 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $281,432 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $1,220,776 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $1,144,880 |
| Contract administrator fees | 2011-12-31 | $100,533 |
| Did the plan have assets held for investment | 2011-12-31 | 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 | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Disclaimer |
| Accountancy firm name | 2011-12-31 | BKD, LLP |
| Accountancy firm EIN | 2011-12-31 | 440160260 |
| 2010 : JACKSON READY-MIX, INC. MEDICAL BENEFITS PLAN 2010 401k financial data |
|---|
| Total income from all sources (including contributions) | 2010-12-31 | $1,508,582 |
| Total of all expenses incurred | 2010-12-31 | $1,764,652 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $1,664,375 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $1,508,543 |
| Value of total assets at end of year | 2010-12-31 | $2,178 |
| Value of total assets at beginning of year | 2010-12-31 | $258,248 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $100,277 |
| Total interest from all sources | 2010-12-31 | $39 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $330,260 |
| Total non interest bearing cash at end of year | 2010-12-31 | $2,178 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $258,248 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-256,070 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $2,178 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $258,248 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $39 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $265,319 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $1,178,283 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $1,399,056 |
| Contract administrator fees | 2010-12-31 | $100,277 |
| Did the plan have assets held for investment | 2010-12-31 | 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 | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Disclaimer |
| Accountancy firm name | 2010-12-31 | BKD, LLP |
| Accountancy firm EIN | 2010-12-31 | 440160260 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL30354 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL30354 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $55,055 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $441,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,055 | | Insurance broker organization code? | 3 | | Insurance broker name | FISHER BROWN BOTTRELL INSURANCE INC |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2DINDBL313 |
| Policy instance | 1 |
| Insurance contract or identification number | 2DINDBL313 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $18,404 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $153,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,404 | | Insurance broker organization code? | 3 | | Insurance broker name | FISHER BROWN BOTTRELL INSURANCE |
|
| HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 231 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $441,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | FOX/EVERETT A DIVISON OF HUB INTER |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2DINDBL313 |
| Policy instance | 1 |
| Insurance contract or identification number | 2DINDBL313 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $17,695 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $151,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,695 | | Insurance broker organization code? | 3 | | Insurance broker name | FISHER BROWN BOTTRELL INSURANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00466561 |
| Policy instance | 1 |
| Insurance contract or identification number | 00466561 | | Number of Individuals Covered | 245 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $7,716 | | Total amount of fees paid to insurance company | USD $796 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $51,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,716 | | Amount paid for insurance broker fees | 796 | | Additional information about fees paid to insurance broker | SERVICE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LUNDY R GUNN |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL30354 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL30354 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $35,252 | | Welfare Benefit Premiums Paid to Carrier | USD $287,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,252 | | Insurance broker organization code? | 3 | | Insurance broker name | FISHER BROWN BOTTRELL INSURANCE |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 7505-MS120-C |
| Policy instance | 2 |
| Insurance contract or identification number | 7505-MS120-C | | Number of Individuals Covered | 230 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $45,674 | | Welfare Benefit Premiums Paid to Carrier | USD $304,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,674 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE INC. |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00466561 |
| Policy instance | 1 |
| Insurance contract or identification number | 00466561 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $7,614 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $50,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,614 | | Insurance broker organization code? | 3 | | Insurance broker name | LUNDY R GUNN |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010003803 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010003803 | | Number of Individuals Covered | 264 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $898 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $5,993 | | 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 | 00010003808 |
| Policy instance | 2 |
| Insurance contract or identification number | 00010003808 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $534 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,554 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LONDON LIFE REINSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 76694 ) |
| Policy contract number | 8509-MS090-L |
| Policy instance | 3 |
| Insurance contract or identification number | 8509-MS090-L | | Number of Individuals Covered | 251 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $42,215 | | Welfare Benefit Premiums Paid to Carrier | USD $281,432 | | 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 | 000010003803 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010003803 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,044 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $40,290 | | 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 | 00010003808 |
| Policy instance | 2 |
| Insurance contract or identification number | 00010003808 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,156 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LONDON LIFE REINSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 76694 ) |
| Policy contract number | 8509-MS090-L |
| Policy instance | 3 |
| Insurance contract or identification number | 8509-MS090-L | | Number of Individuals Covered | 244 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $39,852 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $265,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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