401k Plan data: USRG 401(K) PLAN plan

USRG 401(K) PLAN 401k Plan overview

Plan Name	USRG 401(K) PLAN
Plan identification number	001

USRG 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

USRG MANAGEMENT COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name: USRG MANAGEMENT COMPANY, LLC

Employer identification number (EIN): 770667147

NAIC Classification: 523900

Additional information about USRG MANAGEMENT COMPANY, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4190878

More information about USRG MANAGEMENT COMPANY, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan USRG 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 DEREK BACON
001 2016-01-01 DEREK BACON
001 2015-01-01 DEREK BACON
001 2014-01-01 SHAUN D. LISHMAN 2015-09-15
001 2013-01-01 SHAUN D. LISHMAN 2014-09-18
001 2012-01-01 SHAUN D. LISHMAN 2013-09-30
001 2011-01-01 SHAUN D. LISHMAN 2012-09-25
001 2010-01-01 DEREK Y. BACON 2011-08-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	DEREK BACON
001	2016-01-01	DEREK BACON
001	2015-01-01	DEREK BACON
001	2014-01-01	SHAUN D. LISHMAN	2015-09-15
001	2013-01-01	SHAUN D. LISHMAN	2014-09-18
001	2012-01-01	SHAUN D. LISHMAN	2013-09-30
001	2011-01-01	SHAUN D. LISHMAN	2012-09-25
001	2010-01-01	DEREK Y. BACON	2011-08-09

Plan Statistics for USRG 401(K) PLAN

401k plan membership statisitcs for USRG 401(K) PLAN

Measure Date Value
2020: USRG 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 0
Number of participants with account balances 2020-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: USRG 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 5
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 5
Total of all active and inactive participants 2019-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 10
Number of participants with account balances 2019-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: USRG 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 6
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 7
Total of all active and inactive participants 2018-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 13
Number of participants with account balances 2018-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: USRG 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 7
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 8
Total of all active and inactive participants 2017-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 15
Number of participants with account balances 2017-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: USRG 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 7
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 9
Total of all active and inactive participants 2016-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 16
Number of participants with account balances 2016-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: USRG 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 10
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 8
Total of all active and inactive participants 2015-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 18
Number of participants with account balances 2015-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0

Measure	Date	Value
2020: USRG 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	0
Number of participants with account balances	2020-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: USRG 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	5
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	5
Total of all active and inactive participants	2019-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	10
Number of participants with account balances	2019-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: USRG 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	6
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	7
Total of all active and inactive participants	2018-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	13
Number of participants with account balances	2018-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: USRG 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	7
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	8
Total of all active and inactive participants	2017-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	15
Number of participants with account balances	2017-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: USRG 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	7
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	9
Total of all active and inactive participants	2016-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	16
Number of participants with account balances	2016-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: USRG 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	10
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	8
Total of all active and inactive participants	2015-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	18
Number of participants with account balances	2015-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0

Financial Data on USRG 401(K) PLAN

Measure	Date	Value
2020 : USRG 401(K) PLAN 2020 401k financial data
Transfers to/from the plan	2020-06-30	$0
Total plan liabilities at end of year	2020-06-30	$0
Total plan liabilities at beginning of year	2020-06-30	$0
Total income from all sources	2020-06-30	$-265,999
Expenses. Total of all expenses incurred	2020-06-30	$3,733,801
Benefits paid (including direct rollovers)	2020-06-30	$3,717,230
Total plan assets at end of year	2020-06-30	$0
Total plan assets at beginning of year	2020-06-30	$3,999,800
Value of fidelity bond covering the plan	2020-06-30	$500,000
Total contributions received or receivable from participants	2020-06-30	$900
Expenses. Other expenses not covered elsewhere	2020-06-30	$0
Contributions received from other sources (not participants or employers)	2020-06-30	$0
Other income received	2020-06-30	$-266,899
Noncash contributions received	2020-06-30	$0
Net income (gross income less expenses)	2020-06-30	$-3,999,800
Net plan assets at end of year (total assets less liabilities)	2020-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2020-06-30	$3,999,800
Assets. Value of assets in partnership/joint-venture interests	2020-06-30	$0
Total contributions received or receivable from employer(s)	2020-06-30	$0
Value of certain deemed distributions of participant loans	2020-06-30	$0
Value of corrective distributions	2020-06-30	$15,345
Expenses. Administrative service providers (salaries,fees and commissions)	2020-06-30	$1,226
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-06-30	$0
2019 : USRG 401(K) PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$944,006
Expenses. Total of all expenses incurred	2019-12-31	$1,472,348
Benefits paid (including direct rollovers)	2019-12-31	$1,440,622
Total plan assets at end of year	2019-12-31	$3,999,800
Total plan assets at beginning of year	2019-12-31	$4,528,142
Value of fidelity bond covering the plan	2019-12-31	$500,000
Total contributions received or receivable from participants	2019-12-31	$109,422
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$739,212
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$-528,342
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$3,999,800
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$4,528,142
Assets. Value of assets in partnership/joint-venture interests	2019-12-31	$44,765
Total contributions received or receivable from employer(s)	2019-12-31	$95,372
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$30,302
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$1,424
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : USRG 401(K) PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total income from all sources	2018-12-31	$-14,834
Expenses. Total of all expenses incurred	2018-12-31	$569,555
Benefits paid (including direct rollovers)	2018-12-31	$568,271
Total plan assets at end of year	2018-12-31	$4,528,142
Total plan assets at beginning of year	2018-12-31	$5,112,531
Value of fidelity bond covering the plan	2018-12-31	$500,000
Total contributions received or receivable from participants	2018-12-31	$101,689
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-212,212
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-584,389
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$4,528,142
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$5,112,531
Assets. Value of assets in partnership/joint-venture interests	2018-12-31	$77,902
Total contributions received or receivable from employer(s)	2018-12-31	$95,689
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$1,284
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : USRG 401(K) PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$877,138
Expenses. Total of all expenses incurred	2017-12-31	$579,426
Benefits paid (including direct rollovers)	2017-12-31	$578,281
Total plan assets at end of year	2017-12-31	$5,112,531
Total plan assets at beginning of year	2017-12-31	$4,814,819
Value of fidelity bond covering the plan	2017-12-31	$500,000
Total contributions received or receivable from participants	2017-12-31	$110,681
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$661,776
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$297,712
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$5,112,531
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$4,814,819
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$108,138
Total contributions received or receivable from employer(s)	2017-12-31	$104,681
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$1,145
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : USRG 401(K) PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$512,460
Expenses. Total of all expenses incurred	2016-12-31	$708,854
Benefits paid (including direct rollovers)	2016-12-31	$707,515
Total plan assets at end of year	2016-12-31	$4,814,819
Total plan assets at beginning of year	2016-12-31	$5,011,213
Value of fidelity bond covering the plan	2016-12-31	$500,000
Total contributions received or receivable from participants	2016-12-31	$126,891
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$264,678
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-196,394
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$4,814,819
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$5,011,213
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$29,225
Total contributions received or receivable from employer(s)	2016-12-31	$120,891
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$1,339
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : USRG 401(K) PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$554,633
Expenses. Total of all expenses incurred	2015-12-31	$780,086
Benefits paid (including direct rollovers)	2015-12-31	$779,960
Total plan assets at end of year	2015-12-31	$5,011,213
Total plan assets at beginning of year	2015-12-31	$5,236,666
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$204,164
Contributions received from other sources (not participants or employers)	2015-12-31	$213,267
Other income received	2015-12-31	$-60,962
Net income (gross income less expenses)	2015-12-31	$-225,453
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$5,011,213
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$5,236,666
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$126,776
Total contributions received or receivable from employer(s)	2015-12-31	$198,164
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$126
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0

Form 5500 Responses for USRG 401(K) PLAN

2020: USRG 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: USRG 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: USRG 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: USRG 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: USRG 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: USRG 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

R00118

Policy instance

Insurance contract or identification number	R00118
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-06-30
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

R00118

Policy instance

Insurance contract or identification number	R00118
Number of Individuals Covered	6
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

R00118

Policy instance

Insurance contract or identification number	R00118
Number of Individuals Covered	13
Insurance policy start date	2017-07-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	USRG MANAGEMENT COMPANY, LLC
Employer identification number (EIN):	770667147
NAIC Classification:	523900

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4190878