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SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN
Plan identification number 501

SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

SACRED HEART REHABILITATION CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:SACRED HEART REHABILITATION CENTER, INC.
Employer identification number (EIN):381880385
NAIC Classification:621330
NAIC Description:Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01PAULA NELSON
5012016-07-01PAULA NELSON
5012015-07-01
5012015-07-01PAULA NELSON
5012014-07-01PAULA NELSON
5012012-07-01PAULA NELSON
5012011-07-01PAULA NELSON
5012008-07-01PAULA NELSON
5012007-07-01PAULA NELSON

Plan Statistics for SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN

401k plan membership statisitcs for SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN

Measure Date Value
2022: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01176
Total number of active participants reported on line 7a of the Form 55002022-07-01220
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 participants2022-07-01220
2021: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01160
Total number of active participants reported on line 7a of the Form 55002021-07-01176
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 participants2021-07-01176
2020: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01159
Total number of active participants reported on line 7a of the Form 55002020-07-01160
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 participants2020-07-01160
2019: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01164
Total number of active participants reported on line 7a of the Form 55002019-07-01159
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 participants2019-07-01159
2018: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01169
Total number of active participants reported on line 7a of the Form 55002018-07-01164
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 participants2018-07-01164
2017: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01160
Total number of active participants reported on line 7a of the Form 55002017-07-01169
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 participants2017-07-01169
2016: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01135
Total number of active participants reported on line 7a of the Form 55002016-07-01160
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 participants2016-07-01160
2015: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01127
Total number of active participants reported on line 7a of the Form 55002015-07-01135
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 participants2015-07-01135
2014: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01112
Total number of active participants reported on line 7a of the Form 55002014-07-01127
Total of all active and inactive participants2014-07-01127
Total participants2014-07-01127
2012: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01102
Total number of active participants reported on line 7a of the Form 55002012-07-0197
Total of all active and inactive participants2012-07-0197
Total participants2012-07-0197
2011: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01100
Total number of active participants reported on line 7a of the Form 55002011-07-01102
Total of all active and inactive participants2011-07-01102
Total participants2011-07-01102
2008: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-07-01116
Total number of active participants reported on line 7a of the Form 55002008-07-0196
Total of all active and inactive participants2008-07-0196
Total participants2008-07-0196
2007: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-07-01106
Total number of active participants reported on line 7a of the Form 55002007-07-01116
Total of all active and inactive participants2007-07-01116
Total participants2007-07-01116

Form 5500 Responses for SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN

2022: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedYes
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT 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 benefit arrangement – InsuranceYes
2012: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT 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 benefit arrangement – InsuranceYes
2011: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT 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 benefit arrangement – InsuranceYes
2008: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT 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 benefit arrangement – InsuranceYes
2007: SACRED HEART REHABILITATION CENTER WELFARE BENEFIT PLAN 2007 form 5500 responses
2007-07-01Type of plan entitySingle employer plan
2007-07-01First time form 5500 has been submittedYes
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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 5
Insurance contract or identification number00414645
Number of Individuals Covered193
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $5,193
Total amount of fees paid to insurance companyUSD $5,030
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $513
Insurance broker organization code?3
Amount paid for insurance broker fees5030
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BBCJ
Policy instance 4
Insurance contract or identification numberG000BBCJ
Number of Individuals Covered83
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $4,022
Total amount of fees paid to insurance companyUSD $2,926
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,333
Amount paid for insurance broker fees1815
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BCCJ
Policy instance 3
Insurance contract or identification numberG000BCCJ
Number of Individuals Covered220
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $4,321
Total amount of fees paid to insurance companyUSD $6,858
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,034
Amount paid for insurance broker fees4289
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BCCJ
Policy instance 2
Insurance contract or identification numberG000BCCJ
Number of Individuals Covered220
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $1,680
Total amount of fees paid to insurance companyUSD $1,809
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,358
Amount paid for insurance broker fees1130
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BCCJ
Policy instance 1
Insurance contract or identification numberG000BCCJ
Number of Individuals Covered220
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $3,324
Total amount of fees paid to insurance companyUSD $2,888
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,914
Amount paid for insurance broker fees1806
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered176
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $5,014
Total amount of fees paid to insurance companyUSD $2,793
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,014
Amount paid for insurance broker fees2793
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered160
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $4,725
Total amount of fees paid to insurance companyUSD $1,668
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,725
Amount paid for insurance broker fees1668
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered159
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $5,106
Total amount of fees paid to insurance companyUSD $4,477
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $110,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,106
Amount paid for insurance broker fees4477
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered169
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $16,473
Total amount of fees paid to insurance companyUSD $10,506
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $247,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,473
Amount paid for insurance broker fees10506
Insurance broker organization code?3
Insurance broker nameJ S CLARK AGENCY INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered135
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $14,954
Total amount of fees paid to insurance companyUSD $9,122
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $209,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,954
Amount paid for insurance broker fees9122
Insurance broker organization code?3
Insurance broker nameJ S CLARK AGENCY INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered127
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $14,590
Total amount of fees paid to insurance companyUSD $8,492
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 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 $199,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8492
Commission paid to Insurance BrokerUSD $12
Insurance broker nameJ S CLARK AGENCY INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered97
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered102
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $12,426
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 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 $147,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,426
Insurance broker nameCORNERSTONE BENEFITS LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered96
Insurance policy start date2008-07-01
Insurance policy end date2009-06-30
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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414645
Policy instance 1
Insurance contract or identification number00414645
Number of Individuals Covered116
Insurance policy start date2007-07-01
Insurance policy end date2008-06-30
Total amount of commissions paid to insurance brokerUSD $12,770
Total amount of fees paid to insurance companyUSD $7,450
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 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 $146,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7450
Additional information about fees paid to insurance brokerCOMPENSATION FROM THE EXCEPTIONAL PRODUCER PROGRAM OR THE MASTER BROKER PROGRAM
Commission paid to Insurance BrokerUSD $12,489
Insurance broker nameLUCIDO-MORRIS & ASSO LLC

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