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DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameDEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN
Plan identification number 501

DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT 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)
  • Other welfare benefit cover

401k Sponsoring company profile

DEPAUL COMMUNITY RESOURCES has sponsored the creation of one or more 401k plans.

Company Name:DEPAUL COMMUNITY RESOURCES
Employer identification number (EIN):541108079
NAIC Classification:624100
NAIC Description: Individual and Family Services

Additional information about DEPAUL COMMUNITY RESOURCES

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1977-03-01
Company Identification Number: 0173256
Legal Registered Office Address: 5650 HOLLINS RD
10 S JEFFERSON ST STE 1400
ROANOKE
United States of America (USA)
24019

More information about DEPAUL COMMUNITY RESOURCES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01GREG ADAMS
5012017-01-01GREG ADAMS
5012016-01-01GARY RATLIFF
5012015-01-01GARY RATLIFF
5012014-01-01GARY RATLIFF
5012013-01-01GARY RATLIFF
5012012-12-01LAURA E. SPAFFORD
5012011-12-01LAURA E. SPAFFORD
5012009-12-01LAURA SPAFFORD
5012007-12-01 LAURA SPAFFORD2010-04-21
5012006-12-01LAURA SPAFFORD
5012005-12-01 LAURA SPAFFORD2010-04-21
5012004-12-01 LAURA SPAFFORD2010-04-21
5012003-12-01LAURA SPAFFORD
5012002-12-01 LAURA SPAFFORD2010-04-19
5012001-12-01 LAURA SPAFFORD2010-04-19

Plan Statistics for DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN

Measure Date Value
2022: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01133
Total number of active participants reported on line 7a of the Form 55002022-01-01110
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01110
2021: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01152
Total number of active participants reported on line 7a of the Form 55002021-01-01143
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01143
2020: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01242
Total number of active participants reported on line 7a of the Form 55002020-01-01152
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01152
2019: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01117
Total number of active participants reported on line 7a of the Form 55002019-01-01191
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0151
Total of all active and inactive participants2019-01-01242
2018: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01127
Total number of active participants reported on line 7a of the Form 55002018-01-01108
Number of retired or separated participants receiving benefits2018-01-012
Number of other retired or separated participants entitled to future benefits2018-01-017
Total of all active and inactive participants2018-01-01117
2017: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01128
Total number of active participants reported on line 7a of the Form 55002017-01-01135
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01135
2016: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01139
Total number of active participants reported on line 7a of the Form 55002016-01-01178
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01178
2015: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01139
Total number of active participants reported on line 7a of the Form 55002015-01-01139
Total of all active and inactive participants2015-01-01139
Total participants2015-01-01139
2014: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01128
Total number of active participants reported on line 7a of the Form 55002014-01-01128
Total of all active and inactive participants2014-01-01128
Total participants2014-01-01128
2013: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01231
Total number of active participants reported on line 7a of the Form 55002013-01-01150
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01150
2012: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-01231
Total number of active participants reported on line 7a of the Form 55002012-12-01229
Number of retired or separated participants receiving benefits2012-12-012
Number of other retired or separated participants entitled to future benefits2012-12-010
Total of all active and inactive participants2012-12-01231
2011: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01204
Total number of active participants reported on line 7a of the Form 55002011-12-01229
Number of retired or separated participants receiving benefits2011-12-012
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-01231
2009: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01226
Total number of active participants reported on line 7a of the Form 55002009-12-01215
Total of all active and inactive participants2009-12-01215
Total participants2009-12-01215
2007: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-12-01347
Total number of active participants reported on line 7a of the Form 55002007-12-01392
Number of retired or separated participants receiving benefits2007-12-010
Number of other retired or separated participants entitled to future benefits2007-12-010
Total of all active and inactive participants2007-12-01392
Total participants2007-12-01392
2006: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-12-01326
Total number of active participants reported on line 7a of the Form 55002006-12-01347
Number of retired or separated participants receiving benefits2006-12-010
Number of other retired or separated participants entitled to future benefits2006-12-010
Total of all active and inactive participants2006-12-01347
Total participants2006-12-01347
2005: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year2005-12-01309
Total number of active participants reported on line 7a of the Form 55002005-12-01326
Number of retired or separated participants receiving benefits2005-12-010
Number of other retired or separated participants entitled to future benefits2005-12-010
Total of all active and inactive participants2005-12-01326
Total participants2005-12-01326
2004: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year2004-12-01309
Total number of active participants reported on line 7a of the Form 55002004-12-01326
Number of retired or separated participants receiving benefits2004-12-010
Number of other retired or separated participants entitled to future benefits2004-12-010
Total of all active and inactive participants2004-12-01326
Total participants2004-12-01326
2003: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2003 401k membership
Total participants, beginning-of-year2003-12-01275
Total number of active participants reported on line 7a of the Form 55002003-12-01309
Number of retired or separated participants receiving benefits2003-12-010
Number of other retired or separated participants entitled to future benefits2003-12-010
Total of all active and inactive participants2003-12-01309
Total participants2003-12-01309
2002: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2002 401k membership
Total participants, beginning-of-year2002-12-01261
Total number of active participants reported on line 7a of the Form 55002002-12-01275
Number of retired or separated participants receiving benefits2002-12-010
Number of other retired or separated participants entitled to future benefits2002-12-010
Total of all active and inactive participants2002-12-01275
Total participants2002-12-01275
2001: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2001 401k membership
Total participants, beginning-of-year2001-12-01261
Total number of active participants reported on line 7a of the Form 55002001-12-01261
Number of retired or separated participants receiving benefits2001-12-010
Number of other retired or separated participants entitled to future benefits2001-12-010
Total of all active and inactive participants2001-12-01261
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2001-12-010
Total participants2001-12-01261
Number of participants with account balances2001-12-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2001-12-010

Form 5500 Responses for DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN

2022: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan benefit arrangement – InsuranceYes
2011: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan benefit arrangement – InsuranceYes
2009: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan benefit arrangement – InsuranceYes
2007: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2007 form 5500 responses
2007-12-01Type of plan entitySingle employer plan
2007-12-01Submission has been amendedNo
2007-12-01This submission is the final filingNo
2007-12-01This return/report is a short plan year return/report (less than 12 months)No
2007-12-01Plan is a collectively bargained planNo
2007-12-01Plan funding arrangement – InsuranceYes
2007-12-01Plan benefit arrangement – InsuranceYes
2006: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2006 form 5500 responses
2006-12-01Type of plan entitySingle employer plan
2006-12-01Submission has been amendedNo
2006-12-01This submission is the final filingNo
2006-12-01This return/report is a short plan year return/report (less than 12 months)No
2006-12-01Plan is a collectively bargained planNo
2006-12-01Plan funding arrangement – InsuranceYes
2006-12-01Plan benefit arrangement – InsuranceYes
2005: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2005 form 5500 responses
2005-12-01Type of plan entitySingle employer plan
2005-12-01Submission has been amendedNo
2005-12-01This submission is the final filingNo
2005-12-01This return/report is a short plan year return/report (less than 12 months)No
2005-12-01Plan is a collectively bargained planNo
2005-12-01Plan funding arrangement – InsuranceYes
2005-12-01Plan benefit arrangement – InsuranceYes
2004: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2004 form 5500 responses
2004-12-01Type of plan entitySingle employer plan
2004-12-01Submission has been amendedNo
2004-12-01This submission is the final filingNo
2004-12-01This return/report is a short plan year return/report (less than 12 months)No
2004-12-01Plan is a collectively bargained planNo
2004-12-01Plan funding arrangement – InsuranceYes
2004-12-01Plan benefit arrangement – InsuranceYes
2003: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2003 form 5500 responses
2003-12-01Type of plan entitySingle employer plan
2003-12-01Submission has been amendedNo
2003-12-01This submission is the final filingNo
2003-12-01This return/report is a short plan year return/report (less than 12 months)No
2003-12-01Plan is a collectively bargained planNo
2003-12-01Plan funding arrangement – InsuranceYes
2003-12-01Plan benefit arrangement – InsuranceYes
2002: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2002 form 5500 responses
2002-12-01Type of plan entitySingle employer plan
2002-12-01Submission has been amendedNo
2002-12-01This submission is the final filingNo
2002-12-01This return/report is a short plan year return/report (less than 12 months)No
2002-12-01Plan is a collectively bargained planNo
2002-12-01Plan funding arrangement – InsuranceYes
2002-12-01Plan benefit arrangement – InsuranceYes
2001: DEPAUL FAMILY SERVICES, INC. WELFARE BENEFIT PLAN 2001 form 5500 responses
2001-12-01Type of plan entitySingle employer plan
2001-12-01First time form 5500 has been submittedYes
2001-12-01Submission has been amendedNo
2001-12-01This submission is the final filingNo
2001-12-01This return/report is a short plan year return/report (less than 12 months)No
2001-12-01Plan is a collectively bargained planNo
2001-12-01Plan funding arrangement – InsuranceYes
2001-12-01Plan 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 number00033625
Policy instance 1
Insurance contract or identification number00033625
Number of Individuals Covered136
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $29,727
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER, VOLUNTARY LIFE, VOLUNTARY CRITICAL ILLNESS, VOLUNTARY AD&D, ACCIDENT, 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 CarrierUSD $177,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,494
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00581922
Policy instance 1
Insurance contract or identification number00581922
Number of Individuals Covered138
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $45,653
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER, VOLUNTARY LIFE, VOLUNTARY CRITICAL ILLNESS, VOLUNTARY AD&D, ACCIDENT, 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 CarrierUSD $164,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,746
Insurance broker organization code?3
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG-54543
Policy instance 1
Insurance contract or identification numberG-54543
Number of Individuals Covered152
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $12,474
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, VOLUNTARY LIFE
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 $90,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,474
Insurance broker organization code?3
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG-54543
Policy instance 1
Insurance contract or identification numberG-54543
Number of Individuals Covered150
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $11,127
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, VOLUNTARY LIFE
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 $86,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,127
Insurance broker organization code?3
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG-54543
Policy instance 1
Insurance contract or identification numberG-54543
Number of Individuals Covered160
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $12,078
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, VOLUNTARY LIFE
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 $93,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,078
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0837920
Policy instance 1
Insurance contract or identification number0837920
Number of Individuals Covered159
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
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 $1,192,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG54543
Policy instance 2
Insurance contract or identification numberG54543
Number of Individuals Covered179
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $10,290
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $81,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,290
Insurance broker organization code?3
Insurance broker nameDIGITAL INSURANCE INC

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