401k Plan data: OHIO WILLOW WOOD COMPANY DENTAL PLAN plan

OHIO WILLOW WOOD COMPANY DENTAL PLAN 401k Plan overview

Plan Name	OHIO WILLOW WOOD COMPANY DENTAL PLAN
Plan identification number	502

OHIO WILLOW WOOD COMPANY DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

THE OHIO WILLOW WOOD COMPANY has sponsored the creation of one or more 401k plans.

Company Name: THE OHIO WILLOW WOOD COMPANY

Employer identification number (EIN): 314353637

NAIC Classification: 339110

Additional information about THE OHIO WILLOW WOOD COMPANY

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1945-03-29

Company Identification Number: 189296

Legal Registered Office Address: 15441 SCIOTO DARBY ROAD
-
MT. STERLING
United States of America (USA)
43143

More information about THE OHIO WILLOW WOOD COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OHIO WILLOW WOOD COMPANY DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2012-01-01 DAVID CURTIS
502 2011-01-01 DAVID CURTIS
502 2010-01-01 DAVID CURTIS
502 2009-01-01 DAVID CURTIS
502 2008-01-01 DAVID CURTIS
502 2007-01-01 DAVID CURTIS
502 2006-01-01 DAVID CURTIS
502 2005-01-01 DAVID CURTIS
502 2004-01-01 DAVID CURTIS
502 2003-01-01 DAVID CURTIS
502 2002-01-01 DAVID CURTIS
502 2001-01-01 DAVID CURTIS
502 2000-01-01 DAVID CURTIS
502 1999-01-01 DAVID CURTIS

Plan id#	Filing Submission Date	Name of Administrator
502	2012-01-01	DAVID CURTIS
502	2011-01-01	DAVID CURTIS
502	2010-01-01	DAVID CURTIS
502	2009-01-01	DAVID CURTIS
502	2008-01-01	DAVID CURTIS
502	2007-01-01	DAVID CURTIS
502	2006-01-01	DAVID CURTIS
502	2005-01-01	DAVID CURTIS
502	2004-01-01	DAVID CURTIS
502	2003-01-01	DAVID CURTIS
502	2002-01-01	DAVID CURTIS
502	2001-01-01	DAVID CURTIS
502	2000-01-01	DAVID CURTIS
502	1999-01-01	DAVID CURTIS

Plan Statistics for OHIO WILLOW WOOD COMPANY DENTAL PLAN

401k plan membership statisitcs for OHIO WILLOW WOOD COMPANY DENTAL PLAN

Measure Date Value
2012: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 0
2011: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 130
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 130
2010: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 122
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 122
2009: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 133
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 133
2008: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 100
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 100
2007: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 100
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 0
Total of all active and inactive participants 2007-01-01 100
2006: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2006 401k membership
Total participants, beginning-of-year 2006-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 100
Number of retired or separated participants receiving benefits 2006-01-01 0
Number of other retired or separated participants entitled to future benefits 2006-01-01 0
Total of all active and inactive participants 2006-01-01 100
2005: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2005 401k membership
Total participants, beginning-of-year 2005-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2005-01-01 100
Number of retired or separated participants receiving benefits 2005-01-01 0
Number of other retired or separated participants entitled to future benefits 2005-01-01 0
Total of all active and inactive participants 2005-01-01 100
2004: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2004 401k membership
Total participants, beginning-of-year 2004-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2004-01-01 100
Number of retired or separated participants receiving benefits 2004-01-01 0
Number of other retired or separated participants entitled to future benefits 2004-01-01 0
Total of all active and inactive participants 2004-01-01 100
2003: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2003 401k membership
Total participants, beginning-of-year 2003-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2003-01-01 100
Number of retired or separated participants receiving benefits 2003-01-01 0
Number of other retired or separated participants entitled to future benefits 2003-01-01 0
Total of all active and inactive participants 2003-01-01 100
2002: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2002 401k membership
Total participants, beginning-of-year 2002-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2002-01-01 100
Number of retired or separated participants receiving benefits 2002-01-01 0
Number of other retired or separated participants entitled to future benefits 2002-01-01 0
Total of all active and inactive participants 2002-01-01 100
2001: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2001 401k membership
Total participants, beginning-of-year 2001-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2001-01-01 100
Number of retired or separated participants receiving benefits 2001-01-01 0
Number of other retired or separated participants entitled to future benefits 2001-01-01 0
Total of all active and inactive participants 2001-01-01 100
2000: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2000 401k membership
Total participants, beginning-of-year 2000-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2000-01-01 100
Number of retired or separated participants receiving benefits 2000-01-01 0
Number of other retired or separated participants entitled to future benefits 2000-01-01 0
Total of all active and inactive participants 2000-01-01 100
1999: OHIO WILLOW WOOD COMPANY DENTAL PLAN 1999 401k membership
Total participants, beginning-of-year 1999-01-01 100
Total number of active participants reported on line 7a of the Form 5500 1999-01-01 100
Number of retired or separated participants receiving benefits 1999-01-01 0
Number of other retired or separated participants entitled to future benefits 1999-01-01 0
Total of all active and inactive participants 1999-01-01 100

Measure	Date	Value
2012: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	0
2011: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	130
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	130
2010: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	122
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	122
2009: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	133
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	133
2008: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	100
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	100
2007: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	100
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	0
Total of all active and inactive participants	2007-01-01	100
2006: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	100
Number of retired or separated participants receiving benefits	2006-01-01	0
Number of other retired or separated participants entitled to future benefits	2006-01-01	0
Total of all active and inactive participants	2006-01-01	100
2005: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2005 401k membership
Total participants, beginning-of-year	2005-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	100
Number of retired or separated participants receiving benefits	2005-01-01	0
Number of other retired or separated participants entitled to future benefits	2005-01-01	0
Total of all active and inactive participants	2005-01-01	100
2004: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2004 401k membership
Total participants, beginning-of-year	2004-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2004-01-01	100
Number of retired or separated participants receiving benefits	2004-01-01	0
Number of other retired or separated participants entitled to future benefits	2004-01-01	0
Total of all active and inactive participants	2004-01-01	100
2003: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2003 401k membership
Total participants, beginning-of-year	2003-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2003-01-01	100
Number of retired or separated participants receiving benefits	2003-01-01	0
Number of other retired or separated participants entitled to future benefits	2003-01-01	0
Total of all active and inactive participants	2003-01-01	100
2002: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2002 401k membership
Total participants, beginning-of-year	2002-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2002-01-01	100
Number of retired or separated participants receiving benefits	2002-01-01	0
Number of other retired or separated participants entitled to future benefits	2002-01-01	0
Total of all active and inactive participants	2002-01-01	100
2001: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2001 401k membership
Total participants, beginning-of-year	2001-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2001-01-01	100
Number of retired or separated participants receiving benefits	2001-01-01	0
Number of other retired or separated participants entitled to future benefits	2001-01-01	0
Total of all active and inactive participants	2001-01-01	100
2000: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2000 401k membership
Total participants, beginning-of-year	2000-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2000-01-01	100
Number of retired or separated participants receiving benefits	2000-01-01	0
Number of other retired or separated participants entitled to future benefits	2000-01-01	0
Total of all active and inactive participants	2000-01-01	100
1999: OHIO WILLOW WOOD COMPANY DENTAL PLAN 1999 401k membership
Total participants, beginning-of-year	1999-01-01	100
Total number of active participants reported on line 7a of the Form 5500	1999-01-01	100
Number of retired or separated participants receiving benefits	1999-01-01	0
Number of other retired or separated participants entitled to future benefits	1999-01-01	0
Total of all active and inactive participants	1999-01-01	100

Form 5500 Responses for OHIO WILLOW WOOD COMPANY DENTAL PLAN

2012: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2008: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2006: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2005: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2004: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	Submission has been amended	No
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No
2004-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2003: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2003 form 5500 responses
2003-01-01	Type of plan entity	Single employer plan
2003-01-01	Submission has been amended	No
2003-01-01	This submission is the final filing	No
2003-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2003-01-01	Plan is a collectively bargained plan	No
2003-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2003-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2002: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2002 form 5500 responses
2002-01-01	Type of plan entity	Single employer plan
2002-01-01	Submission has been amended	No
2002-01-01	This submission is the final filing	No
2002-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2002-01-01	Plan is a collectively bargained plan	No
2002-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2002-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2001: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2001 form 5500 responses
2001-01-01	Type of plan entity	Single employer plan
2001-01-01	Submission has been amended	No
2001-01-01	This submission is the final filing	No
2001-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2001-01-01	Plan is a collectively bargained plan	No
2001-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2001-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2000: OHIO WILLOW WOOD COMPANY DENTAL PLAN 2000 form 5500 responses
2000-01-01	Type of plan entity	Single employer plan
2000-01-01	Submission has been amended	No
2000-01-01	This submission is the final filing	No
2000-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2000-01-01	Plan is a collectively bargained plan	No
2000-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2000-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
1999: OHIO WILLOW WOOD COMPANY DENTAL PLAN 1999 form 5500 responses
1999-01-01	Type of plan entity	Single employer plan
1999-01-01	First time form 5500 has been submitted	Yes
1999-01-01	Submission has been amended	No
1999-01-01	This submission is the final filing	No
1999-01-01	This return/report is a short plan year return/report (less than 12 months)	No
1999-01-01	Plan is a collectively bargained plan	No
1999-01-01	Plan funding arrangement – General assets of the sponsor	Yes
1999-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

443350

Policy instance

Insurance contract or identification number	443350
Number of Individuals Covered	131
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $79,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

443350

Policy instance

Insurance contract or identification number	443350
Number of Individuals Covered	130
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $77,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

443350

Policy instance

Insurance contract or identification number	443350
Number of Individuals Covered	122
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,045
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $75,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

Potentially related plans

OHIO WILLOW WOOD COMPANY MEDICAL PLAN [EIN = 834525073]

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Company Name:	THE OHIO WILLOW WOOD COMPANY
Employer identification number (EIN):	314353637
NAIC Classification:	339110

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1945-03-29
Company Identification Number:	189296
Legal Registered Office Address:	15441 SCIOTO DARBY ROAD - MT. STERLING United States of America (USA) 43143