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GUY C LEE BENEFIT PLAN 401k Plan overview

Plan NameGUY C LEE BENEFIT PLAN
Plan identification number 501

GUY C LEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

LAMPE & MALPHRUS LUMBER COMPANY has sponsored the creation of one or more 401k plans.

Company Name:LAMPE & MALPHRUS LUMBER COMPANY
Employer identification number (EIN):561533996
NAIC Classification:321210

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GUY C LEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012020-10-01
5012019-10-01
5012018-10-01
5012017-10-01
5012016-10-01THOMAS A STEPHENSON THOMAS A STEPHENSON2018-07-13

Plan Statistics for GUY C LEE BENEFIT PLAN

401k plan membership statisitcs for GUY C LEE BENEFIT PLAN

Measure Date Value
2020: GUY C LEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01346
Total number of active participants reported on line 7a of the Form 55002020-10-01353
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01353
2019: GUY C LEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01341
Total number of active participants reported on line 7a of the Form 55002019-10-01346
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01346
2018: GUY C LEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01310
Total number of active participants reported on line 7a of the Form 55002018-10-01341
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01341
2017: GUY C LEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01309
Total number of active participants reported on line 7a of the Form 55002017-10-01310
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01310
2016: GUY C LEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01284
Total number of active participants reported on line 7a of the Form 55002016-10-01309
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01309

Financial Data on GUY C LEE BENEFIT PLAN

Measure Date Value
2021 : GUY C LEE BENEFIT PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$430,459
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$193,938
Total income from all sources (including contributions)2021-09-30$3,287,673
Total of all expenses incurred2021-09-30$3,420,906
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-09-30$3,070,492
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-09-30$3,287,673
Value of total assets at end of year2021-09-30$413,048
Value of total assets at beginning of year2021-09-30$309,760
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-09-30$350,414
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-09-30No
Was this plan covered by a fidelity bond2021-09-30Yes
Value of fidelity bond cover2021-09-30$500,000
If this is an individual account plan, was there a blackout period2021-09-30No
Were there any nonexempt tranactions with any party-in-interest2021-09-30No
Contributions received from participants2021-09-30$400,529
Income. Received or receivable in cash from other sources (including rollovers)2021-09-30$12,413
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-09-30$110,704
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-09-30$54,383
Administrative expenses (other) incurred2021-09-30$237,448
Total non interest bearing cash at end of year2021-09-30$302,344
Total non interest bearing cash at beginning of year2021-09-30$253,074
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Value of net income/loss2021-09-30$-133,233
Value of net assets at end of year (total assets less liabilities)2021-09-30$-17,411
Value of net assets at beginning of year (total assets less liabilities)2021-09-30$115,822
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-09-30No
Were any leases to which the plan was party in default or uncollectible2021-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2021-09-30$390,093
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-09-30No
Was there a failure to transmit to the plan any participant contributions2021-09-30No
Has the plan failed to provide any benefit when due under the plan2021-09-30No
Contributions received in cash from employer2021-09-30$2,874,731
Employer contributions (assets) at beginning of year2021-09-30$2,303
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-09-30$2,680,399
Contract administrator fees2021-09-30$112,966
Liabilities. Value of benefit claims payable at end of year2021-09-30$430,459
Liabilities. Value of benefit claims payable at beginning of year2021-09-30$193,938
Did the plan have assets held for investment2021-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-09-30No
Opinion of an independent qualified public accountant for this plan2021-09-30Unqualified
Accountancy firm name2021-09-30WATSON, COOKE & JONES, PA
Accountancy firm EIN2021-09-30203240092
2020 : GUY C LEE BENEFIT PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$193,938
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$226,555
Total income from all sources (including contributions)2020-09-30$3,304,376
Total of all expenses incurred2020-09-30$3,176,312
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-09-30$3,058,034
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-09-30$3,271,757
Value of total assets at end of year2020-09-30$309,760
Value of total assets at beginning of year2020-09-30$214,313
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-09-30$118,278
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-09-30No
Administrative expenses professional fees incurred2020-09-30$5,400
Was this plan covered by a fidelity bond2020-09-30Yes
Value of fidelity bond cover2020-09-30$500,000
If this is an individual account plan, was there a blackout period2020-09-30No
Were there any nonexempt tranactions with any party-in-interest2020-09-30No
Contributions received from participants2020-09-30$560,536
Income. Received or receivable in cash from other sources (including rollovers)2020-09-30$22,467
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-09-30$54,383
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-09-30$12,330
Other income not declared elsewhere2020-09-30$32,619
Administrative expenses (other) incurred2020-09-30$270
Total non interest bearing cash at end of year2020-09-30$253,074
Total non interest bearing cash at beginning of year2020-09-30$201,983
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Value of net income/loss2020-09-30$128,064
Value of net assets at end of year (total assets less liabilities)2020-09-30$115,822
Value of net assets at beginning of year (total assets less liabilities)2020-09-30$-12,242
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-09-30No
Were any leases to which the plan was party in default or uncollectible2020-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2020-09-30$336,125
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-09-30No
Was there a failure to transmit to the plan any participant contributions2020-09-30No
Has the plan failed to provide any benefit when due under the plan2020-09-30No
Contributions received in cash from employer2020-09-30$2,688,754
Employer contributions (assets) at end of year2020-09-30$2,303
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-09-30$2,721,909
Contract administrator fees2020-09-30$112,608
Liabilities. Value of benefit claims payable at end of year2020-09-30$193,938
Liabilities. Value of benefit claims payable at beginning of year2020-09-30$226,555
Did the plan have assets held for investment2020-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-09-30No
Opinion of an independent qualified public accountant for this plan2020-09-30Unqualified
Accountancy firm name2020-09-30WATSON, COOKE & JONES, PA
Accountancy firm EIN2020-09-30203240092
2019 : GUY C LEE BENEFIT PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$226,555
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$180,820
Total income from all sources (including contributions)2019-09-30$2,735,760
Total of all expenses incurred2019-09-30$2,988,596
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-09-30$2,828,621
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-09-30$2,735,760
Value of total assets at end of year2019-09-30$214,313
Value of total assets at beginning of year2019-09-30$421,414
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-09-30$159,975
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-09-30No
Administrative expenses professional fees incurred2019-09-30$5,974
Was this plan covered by a fidelity bond2019-09-30Yes
Value of fidelity bond cover2019-09-30$500,000
If this is an individual account plan, was there a blackout period2019-09-30No
Were there any nonexempt tranactions with any party-in-interest2019-09-30No
Contributions received from participants2019-09-30$563,815
Income. Received or receivable in cash from other sources (including rollovers)2019-09-30$4,469
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-09-30$12,330
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-09-30$16,743
Administrative expenses (other) incurred2019-09-30$46,603
Total non interest bearing cash at end of year2019-09-30$201,983
Total non interest bearing cash at beginning of year2019-09-30$404,671
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Value of net income/loss2019-09-30$-252,836
Value of net assets at end of year (total assets less liabilities)2019-09-30$-12,242
Value of net assets at beginning of year (total assets less liabilities)2019-09-30$240,594
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-09-30No
Were any leases to which the plan was party in default or uncollectible2019-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2019-09-30$300,278
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-09-30No
Was there a failure to transmit to the plan any participant contributions2019-09-30No
Has the plan failed to provide any benefit when due under the plan2019-09-30No
Contributions received in cash from employer2019-09-30$2,167,476
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-09-30$2,528,343
Contract administrator fees2019-09-30$107,398
Liabilities. Value of benefit claims payable at end of year2019-09-30$226,555
Liabilities. Value of benefit claims payable at beginning of year2019-09-30$180,820
Did the plan have assets held for investment2019-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-09-30No
Opinion of an independent qualified public accountant for this plan2019-09-30Unqualified
Accountancy firm name2019-09-30WATSON, COOKE & JONES, PA
Accountancy firm EIN2019-09-30203240092
2018 : GUY C LEE BENEFIT PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$180,820
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$194,035
Total income from all sources (including contributions)2018-09-30$2,477,071
Total of all expenses incurred2018-09-30$2,493,507
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-09-30$2,386,663
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-09-30$2,463,856
Value of total assets at end of year2018-09-30$421,414
Value of total assets at beginning of year2018-09-30$451,065
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-09-30$106,844
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-09-30No
Administrative expenses professional fees incurred2018-09-30$5,400
Was this plan covered by a fidelity bond2018-09-30Yes
Value of fidelity bond cover2018-09-30$500,000
If this is an individual account plan, was there a blackout period2018-09-30No
Were there any nonexempt tranactions with any party-in-interest2018-09-30No
Contributions received from participants2018-09-30$524,097
Income. Received or receivable in cash from other sources (including rollovers)2018-09-30$19,422
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-09-30$16,743
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-09-30$39,794
Other income not declared elsewhere2018-09-30$13,215
Administrative expenses (other) incurred2018-09-30$936
Total non interest bearing cash at end of year2018-09-30$404,671
Total non interest bearing cash at beginning of year2018-09-30$411,271
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Value of net income/loss2018-09-30$-16,436
Value of net assets at end of year (total assets less liabilities)2018-09-30$240,594
Value of net assets at beginning of year (total assets less liabilities)2018-09-30$257,030
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-09-30No
Were any leases to which the plan was party in default or uncollectible2018-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2018-09-30$280,741
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-09-30No
Was there a failure to transmit to the plan any participant contributions2018-09-30No
Has the plan failed to provide any benefit when due under the plan2018-09-30No
Contributions received in cash from employer2018-09-30$1,920,337
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-09-30$2,105,922
Contract administrator fees2018-09-30$100,508
Liabilities. Value of benefit claims payable at end of year2018-09-30$180,820
Liabilities. Value of benefit claims payable at beginning of year2018-09-30$194,035
Did the plan have assets held for investment2018-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-09-30No
Opinion of an independent qualified public accountant for this plan2018-09-30Unqualified
Accountancy firm name2018-09-30WATSON, COOKE & JONES, PA
Accountancy firm EIN2018-09-30203240092
2017 : GUY C LEE BENEFIT PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$194,035
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$187,378
Total income from all sources (including contributions)2017-09-30$2,320,746
Total of all expenses incurred2017-09-30$2,220,454
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-09-30$2,108,189
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-09-30$2,320,746
Value of total assets at end of year2017-09-30$451,065
Value of total assets at beginning of year2017-09-30$344,116
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-09-30$112,265
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-09-30No
Administrative expenses professional fees incurred2017-09-30$5,960
Was this plan covered by a fidelity bond2017-09-30Yes
Value of fidelity bond cover2017-09-30$500,000
If this is an individual account plan, was there a blackout period2017-09-30No
Were there any nonexempt tranactions with any party-in-interest2017-09-30No
Contributions received from participants2017-09-30$517,216
Income. Received or receivable in cash from other sources (including rollovers)2017-09-30$5,237
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-09-30$39,794
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-09-30$4,256
Administrative expenses (other) incurred2017-09-30$7,308
Total non interest bearing cash at end of year2017-09-30$411,271
Total non interest bearing cash at beginning of year2017-09-30$339,860
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Value of net income/loss2017-09-30$100,292
Value of net assets at end of year (total assets less liabilities)2017-09-30$257,030
Value of net assets at beginning of year (total assets less liabilities)2017-09-30$156,738
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-09-30No
Were any leases to which the plan was party in default or uncollectible2017-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-09-30$262,146
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-09-30No
Was there a failure to transmit to the plan any participant contributions2017-09-30No
Has the plan failed to provide any benefit when due under the plan2017-09-30No
Contributions received in cash from employer2017-09-30$1,798,293
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-09-30$1,846,043
Contract administrator fees2017-09-30$98,997
Liabilities. Value of benefit claims payable at end of year2017-09-30$194,035
Liabilities. Value of benefit claims payable at beginning of year2017-09-30$187,378
Did the plan have assets held for investment2017-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-09-30No
Opinion of an independent qualified public accountant for this plan2017-09-30Unqualified
Accountancy firm name2017-09-30WATSON, COOKE & JONES, PA
Accountancy firm EIN2017-09-30203240092

Form 5500 Responses for GUY C LEE BENEFIT PLAN

2020: GUY C LEE BENEFIT PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – TrustYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement - TrustYes
2019: GUY C LEE BENEFIT PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – TrustYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement - TrustYes
2018: GUY C LEE BENEFIT PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement - TrustYes
2017: GUY C LEE BENEFIT PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement - TrustYes
2016: GUY C LEE BENEFIT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL34996
Policy instance 1
Insurance contract or identification numberHCL34996
Number of Individuals Covered350
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Welfare Benefit Premiums Paid to CarrierUSD $352,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5972317
Policy instance 2
Insurance contract or identification number5972317
Number of Individuals Covered417
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $3,300
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $28,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,300
Additional information about fees paid to insurance brokerBASE COMMISSIONS
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL34996
Policy instance 2
Insurance contract or identification numberHCL34996
Number of Individuals Covered326
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Welfare Benefit Premiums Paid to CarrierUSD $309,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016257-00
Policy instance 1
Insurance contract or identification number01-016257-00
Number of Individuals Covered346
Insurance policy start date2019-10-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,921
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $12,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,921
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5972317
Policy instance 3
Insurance contract or identification number5972317
Number of Individuals Covered417
Insurance policy start date2020-06-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $1,369
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,369
Additional information about fees paid to insurance brokerBASE COMMISSIONS
Insurance broker organization code?3
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberG1073-2018R3
Policy instance 2
Insurance contract or identification numberG1073-2018R3
Number of Individuals Covered339
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Welfare Benefit Premiums Paid to CarrierUSD $279,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016257-00
Policy instance 1
Insurance contract or identification number01-016257-00
Number of Individuals Covered312
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $3,107
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $22,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,107
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberG1049-2017R2
Policy instance 2
Insurance contract or identification numberG1049-2017R2
Number of Individuals Covered310
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Welfare Benefit Premiums Paid to CarrierUSD $260,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016257-00
Policy instance 1
Insurance contract or identification number01-016257-00
Number of Individuals Covered312
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $2,976
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $19,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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