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MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 401k Plan overview

Plan NameMANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN
Plan identification number 001

MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN Benefits

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

401k Sponsoring company profile

MANA HEALTH FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name:MANA HEALTH FOODS, INC.
Employer identification number (EIN):990257141
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-01-01
0012016-01-01
0012015-01-01
0012015-01-01
0012014-01-01THERESA THIELK
0012013-01-01THERESA THIELK2014-09-08
0012012-01-01THERESA THIELK2013-07-30
0012011-01-01THERESA THIELK2012-08-15
0012010-01-01THERESA THIELK2011-10-06

Plan Statistics for MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN

401k plan membership statisitcs for MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN

Measure Date Value
2016: MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01148
Total number of active participants reported on line 7a of the Form 55002016-01-0127
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0114
Total of all active and inactive participants2016-01-0141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0141
Number of participants with account balances2016-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01137
Total number of active participants reported on line 7a of the Form 55002015-01-01138
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0110
Total of all active and inactive participants2015-01-01148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01148
Number of participants with account balances2015-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01124
Total number of active participants reported on line 7a of the Form 55002014-01-01128
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-014
Total of all active and inactive participants2014-01-01132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01132
Number of participants with account balances2014-01-0135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010

Financial Data on MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN

Measure Date Value
2016 : MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets2016-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$0
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets to this plan2016-12-31$0
Total transfer of assets from this plan2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$950
Total income from all sources (including contributions)2016-12-31$146,019
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$36,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$35,061
Expenses. Certain deemed distributions of participant loans2016-12-31$0
Value of total corrective distributions2016-12-31$24
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$77,223
Value of total assets at end of year2016-12-31$1,156,329
Value of total assets at beginning of year2016-12-31$1,048,198
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,853
Total income from rents2016-12-31$0
Total interest from all sources2016-12-31$33
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$0
Administrative expenses professional fees incurred2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$125,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$45,806
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$2,193
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$5,117
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$950
Other income not declared elsewhere2016-12-31$3,478
Administrative expenses (other) incurred2016-12-31$0
Total non interest bearing cash at end of year2016-12-31$0
Total non interest bearing cash at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Income. Non cash contributions2016-12-31$0
Value of net income/loss2016-12-31$109,081
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,156,329
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,047,248
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$1,853
Value of interest in pooled separate accounts at end of year2016-12-31$780,873
Value of interest in pooled separate accounts at beginning of year2016-12-31$487,149
Interest on participant loans2016-12-31$33
Income. Interest from loans (other than to participants)2016-12-31$0
Interest earned on other investments2016-12-31$0
Income. Interest from US Government securities2016-12-31$0
Income. Interest from corporate debt instruments2016-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$375,456
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$550,195
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$0
Net investment gain/loss from pooled separate accounts2016-12-31$65,285
Net investment gain or loss from common/collective trusts2016-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$31,417
Employer contributions (assets) at end of year2016-12-31$0
Employer contributions (assets) at beginning of year2016-12-31$3,544
Income. Dividends from preferred stock2016-12-31$0
Income. Dividends from common stock2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$35,061
Contract administrator fees2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$0
Aggregate carrying amount (costs) on sale of assets2016-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31HOLTHOUSE CARLIN & VAN TRIGT LLP
Accountancy firm EIN2016-12-31954345526
2015 : MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets2015-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$0
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets to this plan2015-12-31$0
Total transfer of assets from this plan2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$950
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$694
Expenses. Interest paid2015-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022015-12-31$0
Total income from all sources (including contributions)2015-12-31$108,189
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$1,333
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$0
Expenses. Certain deemed distributions of participant loans2015-12-31$0
Value of total corrective distributions2015-12-31$950
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$112,303
Value of total assets at end of year2015-12-31$1,048,198
Value of total assets at beginning of year2015-12-31$941,086
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$383
Total income from rents2015-12-31$0
Total interest from all sources2015-12-31$64
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$383
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$100,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$65,321
Participant contributions at end of year2015-12-31$2,193
Participant contributions at beginning of year2015-12-31$0
Participant contributions at end of year2015-12-31$5,117
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$950
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$694
Other income not declared elsewhere2015-12-31$0
Administrative expenses (other) incurred2015-12-31$0
Total non interest bearing cash at end of year2015-12-31$0
Total non interest bearing cash at beginning of year2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Income. Non cash contributions2015-12-31$0
Value of net income/loss2015-12-31$106,856
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,047,248
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$940,392
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$0
Value of interest in pooled separate accounts at end of year2015-12-31$487,149
Value of interest in pooled separate accounts at beginning of year2015-12-31$453,014
Interest on participant loans2015-12-31$64
Income. Interest from loans (other than to participants)2015-12-31$0
Interest earned on other investments2015-12-31$0
Income. Interest from US Government securities2015-12-31$0
Income. Interest from corporate debt instruments2015-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$550,195
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$488,072
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$0
Net investment gain/loss from pooled separate accounts2015-12-31$-4,178
Net investment gain or loss from common/collective trusts2015-12-31$0
Net gain/loss from 103.12 investment entities2015-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31Yes
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$46,982
Employer contributions (assets) at end of year2015-12-31$3,544
Employer contributions (assets) at beginning of year2015-12-31$0
Income. Dividends from preferred stock2015-12-31$0
Income. Dividends from common stock2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$0
Contract administrator fees2015-12-31$0
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$0
Aggregate carrying amount (costs) on sale of assets2015-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31HOLTHOUSE CARLIN & VAN TRIGT LLP
Accountancy firm EIN2015-12-31954345526
2014 : MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$694
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$133,543
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$187,635
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$187,267
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$98,005
Value of total assets at end of year2014-12-31$941,086
Value of total assets at beginning of year2014-12-31$994,484
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$368
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$100,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$55,596
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$694
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$0
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Income. Non cash contributions2014-12-31$0
Value of net income/loss2014-12-31$-54,092
Value of net assets at end of year (total assets less liabilities)2014-12-31$940,392
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$994,484
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in pooled separate accounts at end of year2014-12-31$453,014
Value of interest in pooled separate accounts at beginning of year2014-12-31$413,677
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$488,072
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$580,294
Net investment gain/loss from pooled separate accounts2014-12-31$35,538
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$42,409
Employer contributions (assets) at end of year2014-12-31$0
Employer contributions (assets) at beginning of year2014-12-31$513
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$187,267
Contract administrator fees2014-12-31$368
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31HOLTHOUSE CARLIN & VAN TRIGT LLP
Accountancy firm EIN2014-12-31954345526

Form 5500 Responses for MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN

2016: MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 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 – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 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 – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MANA HEALTH FOODS, INC. 401K PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number944304-01
Policy instance 1
Insurance contract or identification number944304-01
Number of Individuals Covered45
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,924
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?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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number944304-01
Policy instance 1
Insurance contract or identification number944304-01
Number of Individuals Covered35
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,833
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?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 $5,833
Insurance broker organization code?3
Insurance broker nameJOHN YEOMAN

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