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J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameJ.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 502

J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

J.V. MANUFACTURING, INC. has sponsored the creation of one or more 401k plans.

Company Name:J.V. MANUFACTURING, INC.
Employer identification number (EIN):710510476
NAIC Classification:333310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-02-01GEORGEANN CRAIG2023-08-25
5022021-02-01GEORGEANN CRAIG2022-06-13 GEORGEANN CRAIG2022-06-13
5022020-02-01GEORGEANN CRAIG2021-10-26 GEORGEANN CRAIG2021-10-26
5022019-02-01GEORGEANN CRAIG2020-08-05 GEORGEANN CRAIG2020-08-05
5022018-02-01GEORGEANN CRAIG2019-08-29 GEORGEANN CRAIG2019-08-29
5022017-02-01GEORGEANN CRAIG
5022016-02-01GEORGEANN CRAIG
5022015-02-01GEORGEANN CRAIG
5022014-02-01GEORGEANN CRAIG
5022013-02-01GEORGEANN CRAIG
5022012-02-01GEORGEANN CRAIG
5022011-02-01GEORGEANN CRAIG
5022010-02-01GEORGEANN CRAIG
5022009-02-01GEORGEANN CRAIG

Plan Statistics for J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01617
Total number of active participants reported on line 7a of the Form 55002022-02-01596
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01596
2021: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01560
Total number of active participants reported on line 7a of the Form 55002021-02-01617
Number of retired or separated participants receiving benefits2021-02-010
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01617
2020: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01557
Total number of active participants reported on line 7a of the Form 55002020-02-01560
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01560
2019: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01203
Total number of active participants reported on line 7a of the Form 55002019-02-01215
Number of retired or separated participants receiving benefits2019-02-010
Total of all active and inactive participants2019-02-01215
2018: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01208
Total number of active participants reported on line 7a of the Form 55002018-02-01203
Number of retired or separated participants receiving benefits2018-02-012
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01205
2017: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-01497
Total number of active participants reported on line 7a of the Form 55002017-02-01490
Total of all active and inactive participants2017-02-01490
Total participants2017-02-01490
2016: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01469
Total number of active participants reported on line 7a of the Form 55002016-02-01497
Total of all active and inactive participants2016-02-01497
Total participants2016-02-01497
2015: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01478
Total number of active participants reported on line 7a of the Form 55002015-02-01469
Total of all active and inactive participants2015-02-01469
Total participants2015-02-01469
2014: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01498
Total number of active participants reported on line 7a of the Form 55002014-02-01478
Total of all active and inactive participants2014-02-01478
Total participants2014-02-01478
2013: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01475
Total number of active participants reported on line 7a of the Form 55002013-02-01498
Total of all active and inactive participants2013-02-01498
Total participants2013-02-01498
2012: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01239
Total number of active participants reported on line 7a of the Form 55002012-02-01475
Total of all active and inactive participants2012-02-01475
Total participants2012-02-01475
2011: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01187
Total number of active participants reported on line 7a of the Form 55002011-02-01239
Total of all active and inactive participants2011-02-01239
Total participants2011-02-01239
2010: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-01219
Total number of active participants reported on line 7a of the Form 55002010-02-01187
Total of all active and inactive participants2010-02-01187
Total participants2010-02-01187
2009: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-01247
Total number of active participants reported on line 7a of the Form 55002009-02-01219
Total of all active and inactive participants2009-02-01219
Total participants2009-02-01219

Form 5500 Responses for J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN

2022: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan funding arrangement – General assets of the sponsorYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – General assets of the sponsorYes
2021: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Submission has been amendedNo
2021-02-01This submission is the final filingNo
2021-02-01This return/report is a short plan year return/report (less than 12 months)No
2021-02-01Plan is a collectively bargained planNo
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan funding arrangement – General assets of the sponsorYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – General assets of the sponsorYes
2020: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Submission has been amendedNo
2020-02-01This submission is the final filingNo
2020-02-01This return/report is a short plan year return/report (less than 12 months)No
2020-02-01Plan is a collectively bargained planNo
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan funding arrangement – General assets of the sponsorYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – General assets of the sponsorYes
2019: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Submission has been amendedNo
2019-02-01This submission is the final filingNo
2019-02-01This return/report is a short plan year return/report (less than 12 months)No
2019-02-01Plan is a collectively bargained planNo
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan funding arrangement – General assets of the sponsorYes
2019-02-01Plan benefit arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – General assets of the sponsorYes
2018: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Submission has been amendedNo
2018-02-01This submission is the final filingNo
2018-02-01This return/report is a short plan year return/report (less than 12 months)No
2018-02-01Plan is a collectively bargained planNo
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan funding arrangement – General assets of the sponsorYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – General assets of the sponsorYes
2017: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Submission has been amendedNo
2017-02-01This submission is the final filingNo
2017-02-01This return/report is a short plan year return/report (less than 12 months)No
2017-02-01Plan is a collectively bargained planNo
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan funding arrangement – General assets of the sponsorYes
2017-02-01Plan benefit arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – General assets of the sponsorYes
2016: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan funding arrangement – General assets of the sponsorYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – General assets of the sponsorYes
2015: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan funding arrangement – General assets of the sponsorYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – General assets of the sponsorYes
2014: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan funding arrangement – General assets of the sponsorYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – General assets of the sponsorYes
2013: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan funding arrangement – General assets of the sponsorYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – General assets of the sponsorYes
2012: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Submission has been amendedNo
2012-02-01This submission is the final filingNo
2012-02-01This return/report is a short plan year return/report (less than 12 months)No
2012-02-01Plan is a collectively bargained planNo
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – General assets of the sponsorYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – General assets of the sponsorYes
2011: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Submission has been amendedNo
2011-02-01This submission is the final filingNo
2011-02-01This return/report is a short plan year return/report (less than 12 months)No
2011-02-01Plan is a collectively bargained planNo
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan funding arrangement – General assets of the sponsorYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – General assets of the sponsorYes
2010: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Submission has been amendedNo
2010-02-01This submission is the final filingNo
2010-02-01This return/report is a short plan year return/report (less than 12 months)No
2010-02-01Plan is a collectively bargained planNo
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan funding arrangement – General assets of the sponsorYes
2010-02-01Plan benefit arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – General assets of the sponsorYes
2009: J.V. MANUFACTURING, INC. EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Submission has been amendedNo
2009-02-01This submission is the final filingNo
2009-02-01This return/report is a short plan year return/report (less than 12 months)No
2009-02-01Plan is a collectively bargained planNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan funding arrangement – General assets of the sponsorYes
2009-02-01Plan benefit arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1110690
Policy instance 1
Insurance contract or identification number1110690
Number of Individuals Covered596
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $34,250
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $280,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,250
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1110690
Policy instance 1
Insurance contract or identification number1110690
Number of Individuals Covered617
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $35,320
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $259,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,785
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1110690
Policy instance 1
Insurance contract or identification number1110690
Number of Individuals Covered627
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $43,109
Total amount of fees paid to insurance companyUSD $2,666
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $300,231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,309
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES & BONUS PAID
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00499311
Policy instance 1
Insurance contract or identification number00499311
Number of Individuals Covered204
Insurance policy start date2019-02-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $7,142
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, AD&D, CANCER, VOLUNTARY CRITICAL ILLNESS, VOLUNTARY HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to CarrierUSD $94,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,142
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL32454
Policy instance 1
Insurance contract or identification numberHCL32454
Number of Individuals Covered190
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00499311
Policy instance 2
Insurance contract or identification number00499311
Number of Individuals Covered196
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $16,442
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $224,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,442
Insurance broker organization code?3
Insurance broker nameWILLIAM J STOCKER
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number52978
Policy instance 3
Insurance contract or identification number52978
Number of Individuals Covered490
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $19,797
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $391,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,797
Insurance broker organization code?3
Insurance broker nameWILLIAM JAMES STOCKER
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number52978
Policy instance 3
Insurance contract or identification number52978
Number of Individuals Covered469
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $17,540
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $366,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,540
Insurance broker organization code?3
Insurance broker nameWILLIAM JAMES STOCKER
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-201779
Policy instance 2
Insurance contract or identification numberUNI-201779
Number of Individuals Covered170
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00499311
Policy instance 1
Insurance contract or identification number00499311
Number of Individuals Covered187
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $16,984
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $228,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,984
Insurance broker organization code?3
Insurance broker nameWILLIAM J STOCKER
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number112889
Policy instance 4
Insurance contract or identification number112889
Number of Individuals Covered203
Insurance policy start date2014-01-01
Insurance policy end date2014-05-01
Total amount of commissions paid to insurance brokerUSD $2,183
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,574
Insurance broker organization code?3
Insurance broker nameSTOCKER, WILLIAM J
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number52978
Policy instance 1
Insurance contract or identification number52978
Number of Individuals Covered478
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $18,122
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,122
Insurance broker organization code?3
Insurance broker nameWILLIAM JAMES STOCKER
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-201779
Policy instance 2
Insurance contract or identification numberUNI-201779
Number of Individuals Covered169
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00499311
Policy instance 3
Insurance contract or identification number00499311
Number of Individuals Covered196
Insurance policy start date2014-05-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,453
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $153,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,453
Insurance broker organization code?3
Insurance broker nameWILLIAM J STOCKER
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number112889
Policy instance 3
Insurance contract or identification number112889
Number of Individuals Covered205
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $9,411
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $60,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,857
Insurance broker organization code?3
Insurance broker nameSTOCKER, WILLIAM J
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number52978
Policy instance 1
Insurance contract or identification number52978
Number of Individuals Covered498
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $18,224
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,224
Insurance broker organization code?3
Insurance broker nameWILLIAM JAMES STOCKER
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number20017154
Policy instance 2
Insurance contract or identification number20017154
Number of Individuals Covered170
Insurance policy start date2013-02-01
Insurance policy end date2013-08-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number52978
Policy instance 2
Insurance contract or identification number52978
Number of Individuals Covered475
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $18,309
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,309
Insurance broker organization code?3
Insurance broker nameWILLIAM JAMES STOCKER
LLOYD'S OF LONDON (National Association of Insurance Commissioners NAIC id number: AA-11 )
Policy contract number20017154
Policy instance 3
Insurance contract or identification number20017154
Number of Individuals Covered180
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Welfare Benefit Premiums Paid to CarrierUSD $225,120
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 number112889
Policy instance 1
Insurance contract or identification number112889
Number of Individuals Covered208
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $9,187
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $62,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,134
Insurance broker organization code?3
Insurance broker nameSTOCKER, WILLIAM J
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number52978
Policy instance 3
Insurance contract or identification number52978
Number of Individuals Covered493
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $19,431
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LLOYD'S OF LONDON (National Association of Insurance Commissioners NAIC id number: AA-11 )
Policy contract number20016707
Policy instance 2
Insurance contract or identification number20016707
Number of Individuals Covered212
Insurance policy start date2010-09-01
Insurance policy end date2012-01-31
Welfare Benefit Premiums Paid to CarrierUSD $240,086
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 number112889
Policy instance 1
Insurance contract or identification number112889
Number of Individuals Covered239
Insurance policy start date2011-01-01
Insurance policy end date2012-01-01
Total amount of commissions paid to insurance brokerUSD $7,845
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $50,691
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 number112889
Policy instance 1
Insurance contract or identification number112889
Number of Individuals Covered187
Insurance policy start date2010-01-01
Insurance policy end date2011-01-01
Total amount of commissions paid to insurance brokerUSD $6,290
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Contracts With Unallocated Funds Deposit Administration1
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH @ DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $39,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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