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CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 401k Plan overview

Plan NameCONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN
Plan identification number 501

CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CONSUMER PRODUCT DISTRIBUTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name:CONSUMER PRODUCT DISTRIBUTORS, INC.
Employer identification number (EIN):042931951
NAIC Classification:424400

Additional information about CONSUMER PRODUCT DISTRIBUTORS, INC.

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division
Incorporation Date: 1996-03-11
Company Identification Number: 66888
Legal Registered Office Address: 17 G W Tatro Dr

Jeffersonville
United States of America (USA)
05464

More information about CONSUMER PRODUCT DISTRIBUTORS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01KIMBERLY COUNTER2023-12-26
5012021-07-01KIMBERLY COUNTER2023-04-25
5012020-07-01KIMBERLY COUNTER2022-01-20
5012019-07-01KIMBERLY COUNTER2021-01-20
5012018-07-01KIMBERLY COUNTER2019-11-12
5012017-07-01
5012016-07-01
5012015-07-01STEPHEN MARTIN
5012014-07-01STEPHEN MARTIN
5012013-07-01STEPHEN MARTIN
5012012-07-01STEPHEN MARTIN
5012011-07-01STEPHEN MARTIN
5012010-07-01STEPHEN MARTIN
5012009-07-01STEPHEN MARTIN
5012008-07-01STEPHEN MARTIN
5012007-07-01STEPHEN MARTIN
5012006-07-01STEPHEN MARTIN
5012005-07-01STEPHEN MARTIN
5012004-07-01STEPHEN MARTIN

Plan Statistics for CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN

401k plan membership statisitcs for CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN

Measure Date Value
2022: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01229
Total number of active participants reported on line 7a of the Form 55002022-07-01269
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01269
Number of employers contributing to the scheme2022-07-010
2021: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01223
Total number of active participants reported on line 7a of the Form 55002021-07-01229
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01229
Number of employers contributing to the scheme2021-07-010
2020: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01223
Total number of active participants reported on line 7a of the Form 55002020-07-01223
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01223
Number of employers contributing to the scheme2020-07-010
2019: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01214
Total number of active participants reported on line 7a of the Form 55002019-07-01223
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01223
Number of employers contributing to the scheme2019-07-010
2018: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01337
Total number of active participants reported on line 7a of the Form 55002018-07-01458
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01458
Number of employers contributing to the scheme2018-07-010
2017: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01301
Total number of active participants reported on line 7a of the Form 55002017-07-01337
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01337
Number of employers contributing to the scheme2017-07-010
2016: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01262
Total number of active participants reported on line 7a of the Form 55002016-07-01301
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01301
2015: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01283
Total number of active participants reported on line 7a of the Form 55002015-07-01262
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01262
2014: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01284
Total number of active participants reported on line 7a of the Form 55002014-07-01263
Number of retired or separated participants receiving benefits2014-07-011
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01264
2013: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01323
Total number of active participants reported on line 7a of the Form 55002013-07-01267
Number of retired or separated participants receiving benefits2013-07-013
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01270
2012: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01304
Total number of active participants reported on line 7a of the Form 55002012-07-01287
Number of retired or separated participants receiving benefits2012-07-015
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01292
2011: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01252
Total number of active participants reported on line 7a of the Form 55002011-07-01273
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01273
2010: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-01247
Total number of active participants reported on line 7a of the Form 55002010-07-01252
Number of retired or separated participants receiving benefits2010-07-010
Number of other retired or separated participants entitled to future benefits2010-07-010
Total of all active and inactive participants2010-07-01252
2009: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01225
Total number of active participants reported on line 7a of the Form 55002009-07-01247
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01247
2008: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year2008-07-01256
Total number of active participants reported on line 7a of the Form 55002008-07-01225
Number of retired or separated participants receiving benefits2008-07-010
Number of other retired or separated participants entitled to future benefits2008-07-010
Total of all active and inactive participants2008-07-01225
2007: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year2007-07-01214
Total number of active participants reported on line 7a of the Form 55002007-07-01256
Number of retired or separated participants receiving benefits2007-07-010
Number of other retired or separated participants entitled to future benefits2007-07-010
Total of all active and inactive participants2007-07-01256
2006: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2006 401k membership
Total participants, beginning-of-year2006-07-01194
Total number of active participants reported on line 7a of the Form 55002006-07-01214
Number of retired or separated participants receiving benefits2006-07-010
Number of other retired or separated participants entitled to future benefits2006-07-010
Total of all active and inactive participants2006-07-01214
2005: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2005 401k membership
Total participants, beginning-of-year2005-07-01202
Total number of active participants reported on line 7a of the Form 55002005-07-01194
Number of retired or separated participants receiving benefits2005-07-010
Number of other retired or separated participants entitled to future benefits2005-07-010
Total of all active and inactive participants2005-07-01194
2004: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2004 401k membership
Total participants, beginning-of-year2004-07-01100
Total number of active participants reported on line 7a of the Form 55002004-07-01202
Number of retired or separated participants receiving benefits2004-07-010
Number of other retired or separated participants entitled to future benefits2004-07-010
Total of all active and inactive participants2004-07-01202

Form 5500 Responses for CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN

2022: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2010: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – General assets of the sponsorYes
2010-07-01Plan benefit arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes
2008: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2008 form 5500 responses
2008-07-01Type of plan entitySingle employer plan
2008-07-01Submission has been amendedNo
2008-07-01This submission is the final filingNo
2008-07-01This return/report is a short plan year return/report (less than 12 months)No
2008-07-01Plan is a collectively bargained planNo
2008-07-01Plan funding arrangement – InsuranceYes
2008-07-01Plan funding arrangement – General assets of the sponsorYes
2008-07-01Plan benefit arrangement – InsuranceYes
2008-07-01Plan benefit arrangement – General assets of the sponsorYes
2007: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2007 form 5500 responses
2007-07-01Type of plan entitySingle employer plan
2007-07-01Submission has been amendedNo
2007-07-01This submission is the final filingNo
2007-07-01This return/report is a short plan year return/report (less than 12 months)No
2007-07-01Plan is a collectively bargained planNo
2007-07-01Plan funding arrangement – InsuranceYes
2007-07-01Plan funding arrangement – General assets of the sponsorYes
2007-07-01Plan benefit arrangement – InsuranceYes
2007-07-01Plan benefit arrangement – General assets of the sponsorYes
2006: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2006 form 5500 responses
2006-07-01Type of plan entitySingle employer plan
2006-07-01Submission has been amendedNo
2006-07-01This submission is the final filingNo
2006-07-01This return/report is a short plan year return/report (less than 12 months)No
2006-07-01Plan is a collectively bargained planNo
2006-07-01Plan funding arrangement – InsuranceYes
2006-07-01Plan funding arrangement – General assets of the sponsorYes
2006-07-01Plan benefit arrangement – InsuranceYes
2006-07-01Plan benefit arrangement – General assets of the sponsorYes
2005: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2005 form 5500 responses
2005-07-01Type of plan entitySingle employer plan
2005-07-01Submission has been amendedNo
2005-07-01This submission is the final filingNo
2005-07-01This return/report is a short plan year return/report (less than 12 months)No
2005-07-01Plan is a collectively bargained planNo
2005-07-01Plan funding arrangement – InsuranceYes
2005-07-01Plan funding arrangement – General assets of the sponsorYes
2005-07-01Plan benefit arrangement – InsuranceYes
2005-07-01Plan benefit arrangement – General assets of the sponsorYes
2004: CONSUMER PRODUCT DISTRIBUTORS, INC. WELFARE PLAN 2004 form 5500 responses
2004-07-01Type of plan entitySingle employer plan
2004-07-01First time form 5500 has been submittedYes
2004-07-01Submission has been amendedNo
2004-07-01This submission is the final filingNo
2004-07-01This return/report is a short plan year return/report (less than 12 months)No
2004-07-01Plan is a collectively bargained planNo
2004-07-01Plan funding arrangement – InsuranceYes
2004-07-01Plan funding arrangement – General assets of the sponsorYes
2004-07-01Plan benefit arrangement – InsuranceYes
2004-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number36909
Policy instance 4
Insurance contract or identification number36909
Number of Individuals Covered269
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $10,109
Total amount of fees paid to insurance companyUSD $2,341
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $124,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,109
Amount paid for insurance broker fees2341
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BKGD
Policy instance 3
Insurance contract or identification numberGVTL0BKGD
Number of Individuals Covered214
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $8,541
Total amount of fees paid to insurance companyUSD $12,897
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,541
Amount paid for insurance broker fees12897
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0BKGD
Policy instance 2
Insurance contract or identification numberGUPR0BKGD
Number of Individuals Covered220
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $5,018
Total amount of fees paid to insurance companyUSD $14,661
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,018
Amount paid for insurance broker fees14661
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0BKGD
Policy instance 1
Insurance contract or identification numberGUC0BKGD
Number of Individuals Covered250
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $3,815
Total amount of fees paid to insurance companyUSD $6,539
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,815
Amount paid for insurance broker fees6539
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0BKGD
Policy instance 2
Insurance contract or identification numberGUC0BKGD
Number of Individuals Covered233
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $17,331
Total amount of fees paid to insurance companyUSD $14,638
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $224,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,750
Amount paid for insurance broker fees13757
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number314875
Policy instance 1
Insurance contract or identification number314875
Number of Individuals Covered444
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $6,770
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $131,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,770
Amount paid for insurance broker fees0
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number314875
Policy instance 1
Insurance contract or identification number314875
Number of Individuals Covered454
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $4,804
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $135,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,804
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0BKGD
Policy instance 2
Insurance contract or identification numberGUC0BKGD
Number of Individuals Covered581
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $23,423
Total amount of fees paid to insurance companyUSD $25,559
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $340,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,423
Amount paid for insurance broker fees25559
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0BKGD
Policy instance 2
Insurance contract or identification numberGUC0BKGD
Number of Individuals Covered307
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $19,733
Total amount of fees paid to insurance companyUSD $6,408
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $311,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,733
Amount paid for insurance broker fees6408
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number314875
Policy instance 1
Insurance contract or identification number314875
Number of Individuals Covered479
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $6,134
Total amount of fees paid to insurance companyUSD $83
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,134
Amount paid for insurance broker fees83
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number314875
Policy instance 2
Insurance contract or identification number314875
Number of Individuals Covered458
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $5,708
Total amount of fees paid to insurance companyUSD $96
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $142,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,708
Amount paid for insurance broker fees96
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number248345
Policy instance 1
Insurance contract or identification number248345
Number of Individuals Covered300
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $12,983
Total amount of fees paid to insurance companyUSD $6,432
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $257,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,983
Amount paid for insurance broker fees6432
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number248345
Policy instance 2
Insurance contract or identification number248345
Number of Individuals Covered337
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $12,184
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $304,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,184
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3337983
Policy instance 1
Insurance contract or identification number3337983
Number of Individuals Covered264
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $4,106
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,106
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number303Z5
Policy instance 2
Insurance contract or identification number303Z5
Number of Individuals Covered301
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $44,300
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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $201,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,205
Insurance broker organization code?3
Insurance broker nameINDIGO INSURANCE SERVICES
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3337983
Policy instance 1
Insurance contract or identification number3337983
Number of Individuals Covered262
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $3,847
Total amount of fees paid to insurance companyUSD $1,536
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 BenefitYes
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 $130,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,847
Insurance broker organization code?3
Amount paid for insurance broker fees1536
Additional information about fees paid to insurance brokerSERVICE/GENERAL AGENT PAYMENTS
Insurance broker nameUSI INSURANCE SERVICES, LLC
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number303Z5
Policy instance 2
Insurance contract or identification number303Z5
Number of Individuals Covered297
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $43,564
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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $198,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,703
Insurance broker organization code?3
Insurance broker nameINDIGO INSURANCE SERVICES
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3337983
Policy instance 1
Insurance contract or identification number3337983
Number of Individuals Covered262
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,114
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 BenefitYes
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 $139,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,114
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number62451/62452
Policy instance 1
Insurance contract or identification number62451/62452
Number of Individuals Covered490
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $7,500
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 BenefitYes
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 $161,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,500
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number62451/62452
Policy instance 1
Insurance contract or identification number62451/62452
Number of Individuals Covered270
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $7,500
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 BenefitYes
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 $149,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,500
Insurance broker organization code?3
Insurance broker nameTD BANKNORTH INSURANCE AGENCY, INC.
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number62451
Policy instance 1
Insurance contract or identification number62451
Number of Individuals Covered444
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $7,500
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 BenefitYes
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 $135,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3220942
Policy instance 1
Insurance contract or identification number3220942
Number of Individuals Covered252
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $8,170
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 BenefitYes
Vision Insurance Welfare BenefitYes
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 $165,417
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 number370192
Policy instance 1
Insurance contract or identification number370192
Number of Individuals Covered225
Insurance policy start date2008-07-01
Insurance policy end date2009-06-30
Total amount of commissions paid to insurance brokerUSD $9,671
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 BenefitYes
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 $179,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,528
Insurance broker organization code?3
Insurance broker nameGIANNINI AND MOREY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number370192
Policy instance 1
Insurance contract or identification number370192
Number of Individuals Covered256
Insurance policy start date2007-07-01
Insurance policy end date2008-06-30
Total amount of commissions paid to insurance brokerUSD $9,013
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 BenefitYes
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 $163,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,880
Insurance broker organization code?3
Insurance broker nameGIANNINI AND MOREY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number370192
Policy instance 1
Insurance contract or identification number370192
Number of Individuals Covered214
Insurance policy start date2006-07-01
Insurance policy end date2007-06-30
Total amount of commissions paid to insurance brokerUSD $8,601
Total amount of fees paid to insurance companyUSD $3,203
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 BenefitYes
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 $147,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,474
Amount paid for insurance broker fees3203
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameGIANNINI AND MOREY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number370192
Policy instance 1
Insurance contract or identification number370192
Number of Individuals Covered194
Insurance policy start date2005-07-01
Insurance policy end date2006-06-30
Total amount of commissions paid to insurance brokerUSD $8,676
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 BenefitYes
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 $149,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,548
Insurance broker organization code?3
Insurance broker nameGIANNINI AND MOREY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number370192
Policy instance 1
Insurance contract or identification number370192
Number of Individuals Covered202
Insurance policy start date2004-07-01
Insurance policy end date2005-06-30
Total amount of commissions paid to insurance brokerUSD $8,388
Total amount of fees paid to insurance companyUSD $7,567
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 BenefitYes
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 $151,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,305
Amount paid for insurance broker fees7567
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameGIANNINI AND MOREY

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