401k Plan data: EXCALIBUR GROUP, LLC GUARDIAN PLAN plan

EXCALIBUR GROUP, LLC GUARDIAN PLAN 401k Plan overview

Plan Name	EXCALIBUR GROUP, LLC GUARDIAN PLAN
Plan identification number	501

EXCALIBUR GROUP, LLC GUARDIAN PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

EXCALIBUR GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: EXCALIBUR GROUP, LLC

Employer identification number (EIN): 223780546

NAIC Classification: 541600

Additional information about EXCALIBUR GROUP, LLC

Jurisdiction of Incorporation: New Jersey Division of Revenue and Enterprise Services

Incorporation Date:

Company Identification Number: 0600071490

More information about EXCALIBUR GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXCALIBUR GROUP, LLC GUARDIAN PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-10-01

Plan Statistics for EXCALIBUR GROUP, LLC GUARDIAN PLAN

401k plan membership statisitcs for EXCALIBUR GROUP, LLC GUARDIAN PLAN

Measure Date Value
2019: EXCALIBUR GROUP, LLC GUARDIAN PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 138
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 138

Measure	Date	Value
2019: EXCALIBUR GROUP, LLC GUARDIAN PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	138
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	138

Form 5500 Responses for EXCALIBUR GROUP, LLC GUARDIAN PLAN

2019: EXCALIBUR GROUP, LLC GUARDIAN PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Multi-employer plan
2019-10-01	First time form 5500 has been submitted	Yes
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	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

556396

Policy instance

Insurance contract or identification number	556396
Number of Individuals Covered	138
Insurance policy start date	2019-10-01
Insurance policy end date	2019-11-30
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 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	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	EXCALIBUR GROUP, LLC
Employer identification number (EIN):	223780546
NAIC Classification:	541600

Jurisdiction of Incorporation:	New Jersey Division of Revenue and Enterprise Services
Incorporation Date:
Company Identification Number:	0600071490