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SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 401k Plan overview

Plan NameSAFETYCALL INTERNATIONAL, LLC 401(K) PLAN
Plan identification number 001

SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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.
  • Plan covering Self-Employed individuals.
  • 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

SAFETYCALL INTERNATIONAL, LLC has sponsored the creation of one or more 401k plans.

Company Name:SAFETYCALL INTERNATIONAL, LLC
Employer identification number (EIN):823701002
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01CHRISTINA LARUE2023-10-11
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01CHRISTINA TORAN2019-05-23

Plan Statistics for SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN

401k plan membership statisitcs for SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN

Measure Date Value
2022: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01200
Total number of active participants reported on line 7a of the Form 55002022-01-01174
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0142
Total of all active and inactive participants2022-01-01216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01216
Number of participants with account balances2022-01-01188
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01164
Total number of active participants reported on line 7a of the Form 55002021-01-01143
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0125
Total of all active and inactive participants2021-01-01168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-01169
Number of participants with account balances2021-01-01155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01151
Total number of active participants reported on line 7a of the Form 55002020-01-01129
Number of retired or separated participants receiving benefits2020-01-012
Number of other retired or separated participants entitled to future benefits2020-01-0119
Total of all active and inactive participants2020-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01150
Number of participants with account balances2020-01-01138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01137
Total number of active participants reported on line 7a of the Form 55002019-01-01124
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-0120
Total of all active and inactive participants2019-01-01146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01146
Number of participants with account balances2019-01-01132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010

Financial Data on SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN

Measure Date Value
2022 : SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-684,816
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$208,912
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$195,271
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,363,162
Value of total assets at end of year2022-12-31$11,663,482
Value of total assets at beginning of year2022-12-31$12,557,210
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$13,641
Total interest from all sources2022-12-31$5,886
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$919,908
Participant contributions at end of year2022-12-31$54,197
Participant contributions at beginning of year2022-12-31$72
Assets. Other investments not covered elsewhere at end of year2022-12-31$1,637,780
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$1,913,912
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$4,199
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$-316,147
Administrative expenses (other) incurred2022-12-31$1,285
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-893,728
Value of net assets at end of year (total assets less liabilities)2022-12-31$11,663,482
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$12,557,210
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$12,356
Value of interest in pooled separate accounts at end of year2022-12-31$9,107,333
Value of interest in pooled separate accounts at beginning of year2022-12-31$9,909,972
Interest earned on other investments2022-12-31$5,886
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$425,117
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$358,507
Net investment gain/loss from pooled separate accounts2022-12-31$-1,737,717
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31Yes
Contributions received in cash from employer2022-12-31$439,055
Employer contributions (assets) at end of year2022-12-31$439,055
Employer contributions (assets) at beginning of year2022-12-31$374,747
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$195,271
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31BAKER TILLY US, LLP
Accountancy firm EIN2022-12-31390859910
2021 : SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$2,876,243
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$86,554
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$73,892
Value of total corrective distributions2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,232,567
Value of total assets at end of year2021-12-31$12,557,210
Value of total assets at beginning of year2021-12-31$9,767,521
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$12,662
Total interest from all sources2021-12-31$4,159
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$789,703
Participant contributions at end of year2021-12-31$72
Participant contributions at beginning of year2021-12-31$1,304
Assets. Other investments not covered elsewhere at end of year2021-12-31$1,913,912
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$1,566,404
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$68,117
Other income not declared elsewhere2021-12-31$280,123
Administrative expenses (other) incurred2021-12-31$855
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$2,789,689
Value of net assets at end of year (total assets less liabilities)2021-12-31$12,557,210
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$9,767,521
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$11,807
Value of interest in pooled separate accounts at end of year2021-12-31$9,909,972
Value of interest in pooled separate accounts at beginning of year2021-12-31$7,431,697
Interest earned on other investments2021-12-31$4,159
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$358,507
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$403,829
Net investment gain/loss from pooled separate accounts2021-12-31$1,359,394
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$374,747
Employer contributions (assets) at end of year2021-12-31$374,747
Employer contributions (assets) at beginning of year2021-12-31$364,287
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$73,892
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BAKER TILLY US, LLP
Accountancy firm EIN2021-12-31390859910
2020 : SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$2,140,980
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$110,894
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$101,154
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,181,962
Value of total assets at end of year2020-12-31$9,767,521
Value of total assets at beginning of year2020-12-31$7,737,435
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$9,740
Total interest from all sources2020-12-31$4,085
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$749,337
Participant contributions at end of year2020-12-31$1,304
Participant contributions at beginning of year2020-12-31$15,000
Assets. Other investments not covered elsewhere at end of year2020-12-31$1,566,404
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$1,373,123
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$68,338
Other income not declared elsewhere2020-12-31$123,513
Administrative expenses (other) incurred2020-12-31$956
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$2,030,086
Value of net assets at end of year (total assets less liabilities)2020-12-31$9,767,521
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$7,737,435
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$8,784
Value of interest in pooled separate accounts at end of year2020-12-31$7,431,697
Value of interest in pooled separate accounts at beginning of year2020-12-31$5,891,966
Interest earned on other investments2020-12-31$4,085
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$403,829
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$144,542
Net investment gain/loss from pooled separate accounts2020-12-31$831,420
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31Yes
Contributions received in cash from employer2020-12-31$364,287
Employer contributions (assets) at end of year2020-12-31$364,287
Employer contributions (assets) at beginning of year2020-12-31$312,804
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$101,154
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31BAKER TILLY US, LLP
Accountancy firm EIN2020-12-31390859910
2019 : SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$2,208,951
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$15,551
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,312
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$977,280
Value of total assets at end of year2019-12-31$7,737,435
Value of total assets at beginning of year2019-12-31$5,544,035
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$11,239
Total interest from all sources2019-12-31$1,967
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Administrative expenses professional fees incurred2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$626,257
Participant contributions at end of year2019-12-31$15,000
Participant contributions at beginning of year2019-12-31$66,809
Assets. Other investments not covered elsewhere at end of year2019-12-31$1,373,123
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$1,078,432
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$34,800
Other income not declared elsewhere2019-12-31$218,655
Administrative expenses (other) incurred2019-12-31$255
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$2,193,400
Value of net assets at end of year (total assets less liabilities)2019-12-31$7,737,435
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$5,544,035
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$10,984
Value of interest in pooled separate accounts at end of year2019-12-31$5,891,966
Value of interest in pooled separate accounts at beginning of year2019-12-31$4,038,618
Interest earned on other investments2019-12-31$1,967
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$144,542
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$96,688
Net investment gain/loss from pooled separate accounts2019-12-31$1,011,049
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$316,223
Employer contributions (assets) at end of year2019-12-31$312,804
Employer contributions (assets) at beginning of year2019-12-31$263,488
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$4,312
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31BAKER TILLY US, LLP
Accountancy firm EIN2019-12-31390859910

Form 5500 Responses for SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN

2022: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: SAFETYCALL INTERNATIONAL, LLC 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number069144
Policy instance 1
Insurance contract or identification number069144
Number of Individuals Covered188
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $24,715
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,715
Insurance broker organization code?3
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number069144
Policy instance 1
Insurance contract or identification number069144
Number of Individuals Covered155
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $24,298
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,298
Insurance broker organization code?3
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number069144
Policy instance 1
Insurance contract or identification number069144
Number of Individuals Covered135
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $19,349
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,349
Insurance broker organization code?3
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number069144
Policy instance 1
Insurance contract or identification number069144
Number of Individuals Covered129
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $16,929
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,929
Insurance broker organization code?3

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