CIU 1-HEALTH WELFARE & HOSPITALIZATION FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN
401k plan membership statisitcs for CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN
| Measure | Date | Value |
|---|
| 2016: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 48 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 45 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 45 |
| 2015: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 49 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 48 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 48 |
| 2014: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 49 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 49 |
| 2013: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 60 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 50 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 50 |
| 2012: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 60 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 60 |
| 2011: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 46 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 50 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 50 |
| 2009: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 81 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 66 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 67 |
| Measure | Date | Value |
|---|
| 2016 : CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $21,407 |
| Total plan liabilities at beginning of year | 2016-12-31 | $18,300 |
| Total income from all sources | 2016-12-31 | $705,405 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $998,016 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $563,008 |
| Total plan assets at end of year | 2016-12-31 | $1,171,999 |
| Total plan assets at beginning of year | 2016-12-31 | $1,461,503 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2016-12-31 | $152 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $409,615 |
| Other income received | 2016-12-31 | $832 |
| Net income (gross income less expenses) | 2016-12-31 | $-292,611 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $1,150,592 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $1,443,203 |
| Assets. Value of real-estate (other than employer real property) | 2016-12-31 | $1,125,000 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $704,573 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $25,393 |
| 2015 : CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $18,300 |
| Total plan liabilities at beginning of year | 2015-12-31 | $19,227 |
| Total income from all sources | 2015-12-31 | $717,408 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $1,077,147 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $640,734 |
| Total plan assets at end of year | 2015-12-31 | $1,461,503 |
| Total plan assets at beginning of year | 2015-12-31 | $1,822,169 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2015-12-31 | $456 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $414,690 |
| Other income received | 2015-12-31 | $14,794 |
| Net income (gross income less expenses) | 2015-12-31 | $-359,739 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $1,443,203 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $1,802,942 |
| Assets. Value of real-estate (other than employer real property) | 2015-12-31 | $1,125,000 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $702,614 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $21,723 |
| 2014 : CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $19,227 |
| Total plan liabilities at beginning of year | 2014-12-31 | $27,208 |
| Total income from all sources | 2014-12-31 | $812,050 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $991,485 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $486,257 |
| Total plan assets at end of year | 2014-12-31 | $1,822,169 |
| Total plan assets at beginning of year | 2014-12-31 | $2,009,585 |
| Value of fidelity bond covering the plan | 2014-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2014-12-31 | $1,178 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $450,978 |
| Other income received | 2014-12-31 | $13,629 |
| Net income (gross income less expenses) | 2014-12-31 | $-179,435 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $1,802,942 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $1,982,377 |
| Assets. Value of real-estate (other than employer real property) | 2014-12-31 | $1,375,000 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $798,421 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $54,250 |
| 2013 : CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $27,208 |
| Total plan liabilities at beginning of year | 2013-12-31 | $9,105 |
| Total income from all sources | 2013-12-31 | $958,752 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $773,910 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $265,439 |
| Total plan assets at end of year | 2013-12-31 | $2,009,585 |
| Total plan assets at beginning of year | 2013-12-31 | $1,806,640 |
| Value of fidelity bond covering the plan | 2013-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2013-12-31 | $2,177 |
| Total contributions received or receivable from participants | 2013-12-31 | $3,143 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $441,566 |
| Other income received | 2013-12-31 | $44,810 |
| Net income (gross income less expenses) | 2013-12-31 | $184,842 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $1,982,377 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $1,797,535 |
| Assets. Value of real-estate (other than employer real property) | 2013-12-31 | $1,375,000 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $910,799 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $66,905 |
| 2012 : CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-12-31 | $9,105 |
| Total plan liabilities at beginning of year | 2012-12-31 | $107,532 |
| Total income from all sources | 2012-12-31 | $1,539,423 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $1,214,758 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $809,436 |
| Total plan assets at end of year | 2012-12-31 | $1,806,640 |
| Total plan assets at beginning of year | 2012-12-31 | $1,580,402 |
| Value of fidelity bond covering the plan | 2012-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2012-12-31 | $3,508 |
| Total contributions received or receivable from participants | 2012-12-31 | $1,048 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $370,976 |
| Other income received | 2012-12-31 | $-53,212 |
| Net income (gross income less expenses) | 2012-12-31 | $324,665 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $1,797,535 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $1,472,870 |
| Assets. Value of real-estate (other than employer real property) | 2012-12-31 | $1,375,000 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $1,591,587 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $34,346 |
| 2011 : CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $107,532 |
| Total plan liabilities at beginning of year | 2011-12-31 | $7,784 |
| Total income from all sources | 2011-12-31 | $954,730 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $1,020,916 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $541,392 |
| Total plan assets at end of year | 2011-12-31 | $1,580,402 |
| Total plan assets at beginning of year | 2011-12-31 | $1,546,840 |
| Value of fidelity bond covering the plan | 2011-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2011-12-31 | $3,166 |
| Total contributions received or receivable from participants | 2011-12-31 | $10,312 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $416,566 |
| Other income received | 2011-12-31 | $274,476 |
| Net income (gross income less expenses) | 2011-12-31 | $-66,186 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $1,472,870 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $1,539,056 |
| Assets. Value of real-estate (other than employer real property) | 2011-12-31 | $1,445,000 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $669,942 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $62,958 |
| 2010 : CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-12-31 | $7,784 |
| Total plan liabilities at beginning of year | 2010-12-31 | $12,940 |
| Total income from all sources | 2010-12-31 | $606,125 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $693,189 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $305,145 |
| Total plan assets at end of year | 2010-12-31 | $1,546,840 |
| Total plan assets at beginning of year | 2010-12-31 | $1,639,060 |
| Value of fidelity bond covering the plan | 2010-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2010-12-31 | $56,435 |
| Total contributions received or receivable from participants | 2010-12-31 | $15,007 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $322,135 |
| Other income received | 2010-12-31 | $35,111 |
| Net income (gross income less expenses) | 2010-12-31 | $-87,064 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $1,539,056 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $1,626,120 |
| Assets. Value of real-estate (other than employer real property) | 2010-12-31 | $1,445,000 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $556,007 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $65,909 |
| 2016: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Multi-employer plan |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Multi-employer plan |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Multi-employer plan |
| 2014-01-01 | Plan is a collectively bargained plan | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Multi-employer plan |
| 2013-01-01 | Plan is a collectively bargained plan | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Multi-employer plan |
| 2012-01-01 | Plan is a collectively bargained plan | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Multi-employer plan |
| 2011-01-01 | Plan is a collectively bargained plan | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: CRAFTSMAN INDEPENDENT UNION HEALTH WELFARE & HOSPITALIZATION PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Multi-employer plan |
| 2009-01-01 | Submission has been amended | Yes |
| 2009-01-01 | Plan is a collectively bargained plan | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00353838 |
| Policy instance | 2 |
| Insurance contract or identification number | 00353838 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $1,850 | | Total amount of fees paid to insurance company | USD $67 | | Welfare Benefit Premiums Paid to Carrier | USD $15,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,850 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 67 | | Insurance broker name | BLUE CHIP CONSORTIUM LLC |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | US439413 |
| Policy instance | 1 |
| Insurance contract or identification number | US439413 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,654 | | Welfare Benefit Premiums Paid to Carrier | USD $265,448 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,654 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADMINISTRATVIE SYSTEMS, LLC |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | XBS10-0056-3 |
| Policy instance | 2 |
| Insurance contract or identification number | XBS10-0056-3 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $11,029 | | Welfare Benefit Premiums Paid to Carrier | USD $275,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,029 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADMINISTRATVIE SYSTEMS, LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00353838 |
| Policy instance | 1 |
| Insurance contract or identification number | 00353838 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $2,300 | | Total amount of fees paid to insurance company | USD $633 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,289 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 633 | | Insurance broker name | DAVID G BOYKIN |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00353838 |
| Policy instance | 1 |
| Insurance contract or identification number | 00353838 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $2,063 | | Total amount of fees paid to insurance company | USD $1,395 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,031 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,053 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1395 | | Insurance broker name | DAVID G BOYKIN |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | XBS10-0056-1 |
| Policy instance | 2 |
| Insurance contract or identification number | XBS10-0056-1 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $10,010 | | Welfare Benefit Premiums Paid to Carrier | USD $250,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,010 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADMINISTRATVIE SYSTEMS, LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00353838 |
| Policy instance | 1 |
| Insurance contract or identification number | 00353838 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $2,369 | | Total amount of fees paid to insurance company | USD $777 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $20,104 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,357 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 777 | | Insurance broker name | DAVID G BOYKIN |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | XBS10-0056-1 |
| Policy instance | 2 |
| Insurance contract or identification number | XBS10-0056-1 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $8,805 | | Welfare Benefit Premiums Paid to Carrier | USD $220,136 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,805 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADMINISTRATVIE SYSTEMS, LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00353838 |
| Policy instance | 1 |
| Insurance contract or identification number | 00353838 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $1,623 | | Total amount of fees paid to insurance company | USD $886 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00353838 |
| Policy instance | 1 |
| Insurance contract or identification number | 00353838 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2009-12-01 | | Insurance policy end date | 2010-11-30 | | Total amount of commissions paid to insurance broker | USD $1,913 | | Total amount of fees paid to insurance company | USD $1,189 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
