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OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 401k Plan overview

Plan NameOSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES
Plan identification number 502

OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

OSBORNE CONSTRUCTION COMPANY has sponsored the creation of one or more 401k plans.

Company Name:OSBORNE CONSTRUCTION COMPANY
Employer identification number (EIN):911389341
NAIC Classification:236200

Additional information about OSBORNE CONSTRUCTION COMPANY

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 1987-09-03
Company Identification Number: 601044042
Legal Registered Office Address: 300 DESCHUTES WAY SW SUITE 304

TUMWATER
United States of America (USA)
985017719

More information about OSBORNE CONSTRUCTION COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01PETRA CARL
5022017-01-01JANICE NELSON JANICE NELSON2018-07-26
5022016-01-01JANICE NELSON
5022015-01-01AMANDA MIKOLASY
5022014-01-01KRISTI PAGANO
5022013-01-01KRISTI PAGANO
5022012-01-01KRISTI PAGANO
5022011-01-01KRISTI PAGANO
5022010-01-01KRISTI PAGANO
5022009-01-01KRISTI PAGANO

Plan Statistics for OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES

401k plan membership statisitcs for OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES

Measure Date Value
2022: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2022 401k membership
Total participants, beginning-of-year2022-01-0142
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-010
2021: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2021 401k membership
Total participants, beginning-of-year2021-01-0147
Total number of active participants reported on line 7a of the Form 55002021-01-0142
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0142
2020: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2020 401k membership
Total participants, beginning-of-year2020-01-0148
Total number of active participants reported on line 7a of the Form 55002020-01-0147
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0147
2019: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2019 401k membership
Total participants, beginning-of-year2019-01-0110
Total number of active participants reported on line 7a of the Form 55002019-01-01127
Number of retired or separated participants receiving benefits2019-01-015
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01132
2018: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2018 401k membership
Total participants, beginning-of-year2018-01-0137
Total number of active participants reported on line 7a of the Form 55002018-01-0110
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0110
2017: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2017 401k membership
Total participants, beginning-of-year2017-01-0133
Total number of active participants reported on line 7a of the Form 55002017-01-0136
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0137
2016: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2016 401k membership
Total participants, beginning-of-year2016-01-0134
Total number of active participants reported on line 7a of the Form 55002016-01-0133
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0133
2015: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2015 401k membership
Total participants, beginning-of-year2015-01-0132
Total number of active participants reported on line 7a of the Form 55002015-01-0132
Number of retired or separated participants receiving benefits2015-01-012
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0134
2014: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2014 401k membership
Total participants, beginning-of-year2014-01-0133
Total number of active participants reported on line 7a of the Form 55002014-01-0130
Number of retired or separated participants receiving benefits2014-01-012
Total of all active and inactive participants2014-01-0132
Total participants2014-01-010
2013: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2013 401k membership
Total participants, beginning-of-year2013-01-0139
Total number of active participants reported on line 7a of the Form 55002013-01-0132
Number of retired or separated participants receiving benefits2013-01-011
Total of all active and inactive participants2013-01-0133
Total participants2013-01-010
2012: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2012 401k membership
Total participants, beginning-of-year2012-01-0148
Total number of active participants reported on line 7a of the Form 55002012-01-0137
Number of retired or separated participants receiving benefits2012-01-012
Total of all active and inactive participants2012-01-0139
2011: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2011 401k membership
Total participants, beginning-of-year2011-01-0142
Total number of active participants reported on line 7a of the Form 55002011-01-0142
Number of retired or separated participants receiving benefits2011-01-012
Total of all active and inactive participants2011-01-0144
2010: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2010 401k membership
Total participants, beginning-of-year2010-01-0138
Total number of active participants reported on line 7a of the Form 55002010-01-0139
Number of retired or separated participants receiving benefits2010-01-013
Total of all active and inactive participants2010-01-0142
2009: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2009 401k membership
Total participants, beginning-of-year2009-01-0136
Total number of active participants reported on line 7a of the Form 55002009-01-0136
Number of retired or separated participants receiving benefits2009-01-012
Total of all active and inactive participants2009-01-0138

Financial Data on OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES

Measure Date Value
2022 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2022 401k financial data
Total income from all sources2022-12-31$2,299,650
Expenses. Total of all expenses incurred2022-12-31$2,374,650
Benefits paid (including direct rollovers)2022-12-31$2,343,681
Total plan assets at beginning of year2022-12-31$75,000
Total contributions received or receivable from participants2022-12-31$210,376
Net income (gross income less expenses)2022-12-31$-75,000
Net plan assets at end of year (total assets less liabilities)2022-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$75,000
Total contributions received or receivable from employer(s)2022-12-31$2,089,274
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$30,969
2021 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2021 401k financial data
Total income from all sources2021-12-31$1,054,090
Expenses. Total of all expenses incurred2021-12-31$994,859
Benefits paid (including direct rollovers)2021-12-31$961,873
Total plan assets at end of year2021-12-31$75,000
Total plan assets at beginning of year2021-12-31$15,769
Total contributions received or receivable from participants2021-12-31$225,359
Net income (gross income less expenses)2021-12-31$59,231
Net plan assets at end of year (total assets less liabilities)2021-12-31$75,000
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$15,769
Total contributions received or receivable from employer(s)2021-12-31$828,731
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$32,986
2020 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2020 401k financial data
Total income from all sources2020-12-31$1,107,544
Expenses. Total of all expenses incurred2020-12-31$1,112,695
Benefits paid (including direct rollovers)2020-12-31$1,093,488
Total plan assets at end of year2020-12-31$15,769
Total plan assets at beginning of year2020-12-31$20,920
Total contributions received or receivable from participants2020-12-31$234,962
Other income received2020-12-31$3
Net income (gross income less expenses)2020-12-31$-5,151
Net plan assets at end of year (total assets less liabilities)2020-12-31$15,769
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$20,920
Total contributions received or receivable from employer(s)2020-12-31$872,579
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$19,207
2019 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2019 401k financial data
Total income from all sources2019-12-31$1,038,446
Expenses. Total of all expenses incurred2019-12-31$1,021,118
Benefits paid (including direct rollovers)2019-12-31$1,002,005
Total plan assets at end of year2019-12-31$20,920
Total plan assets at beginning of year2019-12-31$3,592
Total contributions received or receivable from participants2019-12-31$243,761
Net income (gross income less expenses)2019-12-31$17,328
Net plan assets at end of year (total assets less liabilities)2019-12-31$20,920
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$3,592
Total contributions received or receivable from employer(s)2019-12-31$794,685
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$19,113
2018 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2018 401k financial data
Total income from all sources2018-12-31$1,134,037
Expenses. Total of all expenses incurred2018-12-31$1,133,404
Benefits paid (including direct rollovers)2018-12-31$1,133,053
Total plan assets at end of year2018-12-31$3,592
Total plan assets at beginning of year2018-12-31$2,959
Total contributions received or receivable from participants2018-12-31$245,673
Expenses. Other expenses not covered elsewhere2018-12-31$351
Net income (gross income less expenses)2018-12-31$633
Net plan assets at end of year (total assets less liabilities)2018-12-31$3,592
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$2,959
Total contributions received or receivable from employer(s)2018-12-31$888,364
2017 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2017 401k financial data
Total income from all sources2017-12-31$611,144
Expenses. Total of all expenses incurred2017-12-31$611,051
Benefits paid (including direct rollovers)2017-12-31$589,149
Total plan assets at end of year2017-12-31$2,959
Total plan assets at beginning of year2017-12-31$2,866
Total contributions received or receivable from participants2017-12-31$169,983
Expenses. Other expenses not covered elsewhere2017-12-31$625
Net income (gross income less expenses)2017-12-31$93
Net plan assets at end of year (total assets less liabilities)2017-12-31$2,959
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$2,866
Total contributions received or receivable from employer(s)2017-12-31$441,161
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$21,277
2016 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2016 401k financial data
Total income from all sources2016-12-31$658,240
Expenses. Total of all expenses incurred2016-12-31$666,397
Benefits paid (including direct rollovers)2016-12-31$635,771
Total plan assets at end of year2016-12-31$2,866
Total plan assets at beginning of year2016-12-31$11,023
Total contributions received or receivable from participants2016-12-31$147,601
Expenses. Other expenses not covered elsewhere2016-12-31$551
Net income (gross income less expenses)2016-12-31$-8,157
Net plan assets at end of year (total assets less liabilities)2016-12-31$2,866
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$11,023
Total contributions received or receivable from employer(s)2016-12-31$510,639
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$30,075
2015 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2015 401k financial data
Total income from all sources2015-12-31$609,662
Expenses. Total of all expenses incurred2015-12-31$605,087
Benefits paid (including direct rollovers)2015-12-31$576,299
Total plan assets at end of year2015-12-31$11,023
Total plan assets at beginning of year2015-12-31$6,448
Total contributions received or receivable from participants2015-12-31$150,576
Expenses. Other expenses not covered elsewhere2015-12-31$675
Net income (gross income less expenses)2015-12-31$4,575
Net plan assets at end of year (total assets less liabilities)2015-12-31$11,023
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$6,448
Total contributions received or receivable from employer(s)2015-12-31$459,086
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$28,113
2014 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2014 401k financial data
Total income from all sources2014-12-31$570,580
Expenses. Total of all expenses incurred2014-12-31$578,989
Benefits paid (including direct rollovers)2014-12-31$552,200
Total plan assets at end of year2014-12-31$6,448
Total plan assets at beginning of year2014-12-31$14,857
Total contributions received or receivable from participants2014-12-31$126,859
Net income (gross income less expenses)2014-12-31$-8,409
Net plan assets at end of year (total assets less liabilities)2014-12-31$6,448
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$14,857
Total contributions received or receivable from employer(s)2014-12-31$443,721
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$26,789
2013 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2013 401k financial data
Total income from all sources2013-12-31$841,447
Expenses. Total of all expenses incurred2013-12-31$830,142
Benefits paid (including direct rollovers)2013-12-31$803,759
Total plan assets at end of year2013-12-31$14,857
Total plan assets at beginning of year2013-12-31$3,552
Total contributions received or receivable from participants2013-12-31$30,385
Net income (gross income less expenses)2013-12-31$11,305
Net plan assets at end of year (total assets less liabilities)2013-12-31$14,857
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$3,552
Total contributions received or receivable from employer(s)2013-12-31$811,062
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$26,383
2012 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2012 401k financial data
Total income from all sources2012-12-31$780,675
Expenses. Total of all expenses incurred2012-12-31$780,979
Benefits paid (including direct rollovers)2012-12-31$745,400
Total plan assets at end of year2012-12-31$3,552
Total plan assets at beginning of year2012-12-31$3,856
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$28,828
Net income (gross income less expenses)2012-12-31$-304
Net plan assets at end of year (total assets less liabilities)2012-12-31$3,552
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$3,856
Total contributions received or receivable from employer(s)2012-12-31$751,847
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$35,579
2011 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2011 401k financial data
Total income from all sources2011-12-31$886,638
Expenses. Total of all expenses incurred2011-12-31$886,362
Benefits paid (including direct rollovers)2011-12-31$883,187
Total plan assets at end of year2011-12-31$3,857
Total plan assets at beginning of year2011-12-31$3,581
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$20,810
Other income received2011-12-31$1
Net income (gross income less expenses)2011-12-31$276
Net plan assets at end of year (total assets less liabilities)2011-12-31$3,857
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$3,581
Total contributions received or receivable from employer(s)2011-12-31$865,827
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$3,175
2010 : OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2010 401k financial data
Total income from all sources2010-12-31$506,541
Expenses. Total of all expenses incurred2010-12-31$539,995
Benefits paid (including direct rollovers)2010-12-31$536,700
Total plan assets at end of year2010-12-31$3,581
Total plan assets at beginning of year2010-12-31$37,035
Value of fidelity bond covering the plan2010-12-31$5,000,000
Total contributions received or receivable from participants2010-12-31$23,668
Other income received2010-12-31$1
Net income (gross income less expenses)2010-12-31$-33,454
Net plan assets at end of year (total assets less liabilities)2010-12-31$3,581
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$37,035
Total contributions received or receivable from employer(s)2010-12-31$482,872
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$3,295

Form 5500 Responses for OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES

2022: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 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 filingYes
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 – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
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 – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 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 – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 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 – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: OSBORNE CONSTRUCTION CO EMPLOYEE BENEFIT TRUST FOR SALARIED EMPLOYEES 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberEAP
Policy instance 3
Insurance contract or identification numberEAP
Number of Individuals Covered40
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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?No
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 1
Insurance contract or identification number235168
Number of Individuals Covered51
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $612
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $29,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees612
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 2
Insurance contract or identification numberHCL17663
Number of Individuals Covered36
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $170,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberEAP
Policy instance 2
Insurance contract or identification numberEAP
Number of Individuals Covered50
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?No
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 1
Insurance contract or identification number235168
Number of Individuals Covered50
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $32,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 3
Insurance contract or identification numberHCL17663
Number of Individuals Covered41
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $160,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 1
Insurance contract or identification number235168
Number of Individuals Covered49
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $22,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 2
Insurance contract or identification numberHCL17663
Number of Individuals Covered44
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $175,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 2
Insurance contract or identification numberHCL17663
Number of Individuals Covered53
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $215,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 1
Insurance contract or identification number235168
Number of Individuals Covered59
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $783
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $28,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees783
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 2
Insurance contract or identification number235168
Number of Individuals Covered18
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $18,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 1
Insurance contract or identification numberHCL17663
Number of Individuals Covered15
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $47,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 1
Insurance contract or identification numberHCL17663
Number of Individuals Covered37
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $153,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 2
Insurance contract or identification number235168
Number of Individuals Covered41
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $485
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $16,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees485
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker namePARKER SMITH & FEEK INC.
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 2
Insurance contract or identification numberHCL17663
Number of Individuals Covered70
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $8,375
Total amount of fees paid to insurance companyUSD $2,546
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $104,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,375
Insurance broker organization code?3
Amount paid for insurance broker fees2546
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker nameOSBORNE CONSTRUCTION COMPANY
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 1
Insurance contract or identification numberHCL17663
Number of Individuals Covered31
Insurance policy start date2015-02-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,680
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Welfare Benefit Premiums Paid to CarrierUSD $108,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,680
Insurance broker organization code?3
Insurance broker nameAXIS INSURANCE LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 3
Insurance contract or identification number235168
Number of Individuals Covered32
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $1,525
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,525
Insurance broker organization code?3
Insurance broker nameAXIS INSURANCE LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract numberK1900821
Policy instance 2
Insurance contract or identification numberK1900821
Number of Individuals Covered70
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,143
Total amount of fees paid to insurance companyUSD $733
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,143
Amount paid for insurance broker fees733
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameCONOVER INSURANCE
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number235168
Policy instance 3
Insurance contract or identification number235168
Number of Individuals Covered32
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,525
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,525
Insurance broker organization code?3
Insurance broker nameAXIS INSURANCE LLC
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 1
Insurance contract or identification numberHCL17663
Number of Individuals Covered70
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $8,375
Total amount of fees paid to insurance companyUSD $2,546
Welfare Benefit Premiums Paid to CarrierUSD $104,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,375
Insurance broker organization code?3
Amount paid for insurance broker fees2546
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker nameOSBORNE CONSTRUCTION COMPANY
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number
Policy instance 1
Number of Individuals Covered70
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $11,736
Total amount of fees paid to insurance companyUSD $1,619
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,736
Insurance broker organization code?3
Amount paid for insurance broker fees1619
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker nameOSBORNE CONSTRUCTION COMPANY
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5462033
Policy instance 2
Insurance contract or identification number5462033
Number of Individuals Covered33
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,516
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,516
Insurance broker organization code?3
Insurance broker nameAXIS INSURANCE LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract numberK1900821
Policy instance 3
Insurance contract or identification numberK1900821
Number of Individuals Covered33
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $3,367
Total amount of fees paid to insurance companyUSD $1,338
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,367
Amount paid for insurance broker fees1338
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameCONOVER INSURANCE
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number
Policy instance 1
Number of Individuals Covered39
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $10,796
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $107,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,796
Insurance broker organization code?3
Insurance broker nameAXIS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1009695
Policy instance 1
Insurance contract or identification number1009695
Number of Individuals Covered144
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $6,955
Total amount of fees paid to insurance companyUSD $824
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17663
Policy instance 2
Insurance contract or identification numberHCL17663
Number of Individuals Covered86
Insurance policy start date2011-02-01
Insurance policy end date2012-01-01
Total amount of commissions paid to insurance brokerUSD $11,488
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1009695
Policy instance 3
Insurance contract or identification number1009695
Number of Individuals Covered42
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $4,505
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,505
Insurance broker organization code?3
Insurance broker nameAXIS LLC DBA CONOVER INSURANCE
BENEFIT MD (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberOSBORN1
Policy instance 2
Insurance contract or identification numberOSBORN1
Number of Individuals Covered42
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $8,277
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,277
Insurance broker organization code?3
Insurance broker nameAXIS LLC DBA CONOVER INSURANCE
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number803731
Policy instance 1
Insurance contract or identification number803731
Number of Individuals Covered42
Insurance policy start date2009-07-01
Insurance policy end date2010-01-31
Total amount of commissions paid to insurance brokerUSD $9,782
Total amount of fees paid to insurance companyUSD $542
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $200,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,782
Amount paid for insurance broker fees542
Additional information about fees paid to insurance brokerCROSS SALE
Insurance broker organization code?3
Insurance broker nameAXIS LLC DBA CONOVER INSURANCE

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