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HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 401k Plan overview

Plan NameHOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE
Plan identification number 503

HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

HOLSTEIN ASSOCIATION USA, INC. has sponsored the creation of one or more 401k plans.

Company Name:HOLSTEIN ASSOCIATION USA, INC.
Employer identification number (EIN):030130760
NAIC Classification:115210
NAIC Description:Support Activities for Animal Production

Additional information about HOLSTEIN ASSOCIATION USA, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1914-01-02
Company Identification Number: 12347
Legal Registered Office Address: ONE HOLSTEIN PLACE
Onondaga
BRATTLEBORO
United States of America (USA)
053010808

More information about HOLSTEIN ASSOCIATION USA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032021-09-01
5032020-09-01
5032019-09-01
5032018-09-01
5032017-09-01BARBARA CASNA BARBARA CASNA2019-03-25
5032016-09-01BARBARA CASNA BARBARA CASNA2018-03-09
5032015-09-01BARBARA CASNA BARBARA CASNA2017-03-08
5032014-09-01BARBARA CASNA BARBARA CASNA2016-03-16
5032013-09-01BARBARA CASNA BARBARA CASNA2015-03-20
5032012-09-01BARBARA CASNA BARBARA CASNA2014-03-26
5032011-09-01BARBARA CASNA
5032009-09-01BARBARA CASNA

Plan Statistics for HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE

401k plan membership statisitcs for HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE

Measure Date Value
2021: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-09-0194
Total number of active participants reported on line 7a of the Form 55002021-09-0193
Total of all active and inactive participants2021-09-0193
Total participants2021-09-0193
2020: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-09-0196
Total number of active participants reported on line 7a of the Form 55002020-09-0194
Total of all active and inactive participants2020-09-0194
Total participants2020-09-0194
2019: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-09-01101
Total number of active participants reported on line 7a of the Form 55002019-09-0196
Total of all active and inactive participants2019-09-0196
Total participants2019-09-0196
2018: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-09-01108
Total number of active participants reported on line 7a of the Form 55002018-09-01101
Total of all active and inactive participants2018-09-01101
Total participants2018-09-01101
2017: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-09-01113
Total number of active participants reported on line 7a of the Form 55002017-09-01108
Total of all active and inactive participants2017-09-01108
Total participants2017-09-01108
2016: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-09-01116
Total number of active participants reported on line 7a of the Form 55002016-09-01113
Total of all active and inactive participants2016-09-01113
Total participants2016-09-01113
2015: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-09-01114
Total number of active participants reported on line 7a of the Form 55002015-09-01116
Total of all active and inactive participants2015-09-01116
Total participants2015-09-01116
2014: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-09-01112
Total number of active participants reported on line 7a of the Form 55002014-09-01114
Total of all active and inactive participants2014-09-01114
Total participants2014-09-01114
2013: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-09-01115
Total number of active participants reported on line 7a of the Form 55002013-09-01112
Total of all active and inactive participants2013-09-01112
Total participants2013-09-01112
2012: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-09-01115
Total number of active participants reported on line 7a of the Form 55002012-09-01115
Total of all active and inactive participants2012-09-01115
Total participants2012-09-01115
2011: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-09-01115
Total number of active participants reported on line 7a of the Form 55002011-09-01115
Total of all active and inactive participants2011-09-01115
Total participants2011-09-01115
2009: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-09-01130
Total number of active participants reported on line 7a of the Form 55002009-09-01117
Total of all active and inactive participants2009-09-01117
Total participants2009-09-01117

Form 5500 Responses for HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE

2021: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Submission has been amendedNo
2021-09-01This submission is the final filingNo
2021-09-01This return/report is a short plan year return/report (less than 12 months)No
2021-09-01Plan is a collectively bargained planNo
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Submission has been amendedNo
2020-09-01This submission is the final filingNo
2020-09-01This return/report is a short plan year return/report (less than 12 months)No
2020-09-01Plan is a collectively bargained planNo
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Submission has been amendedNo
2019-09-01This submission is the final filingNo
2019-09-01This return/report is a short plan year return/report (less than 12 months)No
2019-09-01Plan is a collectively bargained planNo
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Submission has been amendedNo
2018-09-01This submission is the final filingNo
2018-09-01This return/report is a short plan year return/report (less than 12 months)No
2018-09-01Plan is a collectively bargained planNo
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Submission has been amendedNo
2017-09-01This submission is the final filingNo
2017-09-01This return/report is a short plan year return/report (less than 12 months)No
2017-09-01Plan is a collectively bargained planNo
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Submission has been amendedNo
2014-09-01This submission is the final filingNo
2014-09-01This return/report is a short plan year return/report (less than 12 months)No
2014-09-01Plan is a collectively bargained planNo
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Submission has been amendedNo
2013-09-01This submission is the final filingNo
2013-09-01This return/report is a short plan year return/report (less than 12 months)No
2013-09-01Plan is a collectively bargained planNo
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Submission has been amendedNo
2012-09-01This submission is the final filingNo
2012-09-01This return/report is a short plan year return/report (less than 12 months)No
2012-09-01Plan is a collectively bargained planNo
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Submission has been amendedNo
2011-09-01This submission is the final filingNo
2011-09-01This return/report is a short plan year return/report (less than 12 months)No
2011-09-01Plan is a collectively bargained planNo
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2009: HOLSTEIN ASSOCIATION USA, INC. GROUP LIFE INSURANCE 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Submission has been amendedNo
2009-09-01This submission is the final filingNo
2009-09-01This return/report is a short plan year return/report (less than 12 months)No
2009-09-01Plan is a collectively bargained planNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159595
Policy instance 1
Insurance contract or identification numberGL 159595
Number of Individuals Covered93
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $716
Total amount of fees paid to insurance companyUSD $176
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 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 $9,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $716
Amount paid for insurance broker fees176
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159595
Policy instance 1
Insurance contract or identification numberGL 159595
Number of Individuals Covered94
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $706
Total amount of fees paid to insurance companyUSD $180
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 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 $9,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $706
Amount paid for insurance broker fees180
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL159595
Policy instance 1
Insurance contract or identification numberGL159595
Number of Individuals Covered96
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $685
Total amount of fees paid to insurance companyUSD $391
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 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 $10,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $685
Amount paid for insurance broker fees391
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL159595
Policy instance 1
Insurance contract or identification numberGL159595
Number of Individuals Covered101
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $719
Total amount of fees paid to insurance companyUSD $150
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 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 $10,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $719
Amount paid for insurance broker fees150
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number59994
Policy instance 1
Insurance contract or identification number59994
Number of Individuals Covered108
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,012
Total amount of fees paid to insurance companyUSD $40
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 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 $16,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number59994
Policy instance 1
Insurance contract or identification number59994
Number of Individuals Covered116
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $1,060
Total amount of fees paid to insurance companyUSD $42
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 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 $15,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees42
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameRICHARDS INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number59994
Policy instance 1
Insurance contract or identification number59994
Number of Individuals Covered114
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $1,040
Total amount of fees paid to insurance companyUSD $40
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 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 $15,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,040
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEE
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number59994
Policy instance 1
Insurance contract or identification number59994
Number of Individuals Covered112
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $1,077
Total amount of fees paid to insurance companyUSD $41
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 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 $15,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees41
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEE
Insurance broker organization code?5
Insurance broker nameTHE RICHARDS GROUP
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number59994
Policy instance 1
Insurance contract or identification number59994
Number of Individuals Covered115
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $1,056
Total amount of fees paid to insurance companyUSD $42
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 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 $14,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees42
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $1,056
Insurance broker nameTHE RICHARDS GROUP
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number59994
Policy instance 1
Insurance contract or identification number59994
Number of Individuals Covered115
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $985
Total amount of fees paid to insurance companyUSD $41
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number59994
Policy instance 1
Insurance contract or identification number59994
Number of Individuals Covered115
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $1,001
Total amount of fees paid to insurance companyUSD $42
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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