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ENERGY AIR, INC. DENTAL PLAN 401k Plan overview

Plan NameENERGY AIR, INC. DENTAL PLAN
Plan identification number 503

ENERGY AIR, INC. DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental

401k Sponsoring company profile

ENERGY AIR, INC. has sponsored the creation of one or more 401k plans.

Company Name:ENERGY AIR, INC.
Employer identification number (EIN):592040096
NAIC Classification:238220
NAIC Description:Plumbing, Heating, and Air-Conditioning Contractors

Additional information about ENERGY AIR, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1979-09-28
Company Identification Number: 637845
Legal Registered Office Address: 5401 Energy Air Ct

Orlando

32810

More information about ENERGY AIR, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENERGY AIR, INC. DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032013-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032012-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032011-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032010-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032009-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032008-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032007-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032006-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032005-05-01KEITH DANIELS CHARLES KULP2016-03-15
5032004-05-01KEITH DANIELS CHARLES KULP2016-03-15

Plan Statistics for ENERGY AIR, INC. DENTAL PLAN

401k plan membership statisitcs for ENERGY AIR, INC. DENTAL PLAN

Measure Date Value
2013: ENERGY AIR, INC. DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01151
Total number of active participants reported on line 7a of the Form 55002013-05-010
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-010
2012: ENERGY AIR, INC. DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01135
Total number of active participants reported on line 7a of the Form 55002012-05-01151
Number of retired or separated participants receiving benefits2012-05-011
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-01152
2011: ENERGY AIR, INC. DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01146
Total number of active participants reported on line 7a of the Form 55002011-05-01135
Number of retired or separated participants receiving benefits2011-05-014
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-01139
2010: ENERGY AIR, INC. DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-05-01173
Total number of active participants reported on line 7a of the Form 55002010-05-01146
Number of retired or separated participants receiving benefits2010-05-011
Number of other retired or separated participants entitled to future benefits2010-05-010
Total of all active and inactive participants2010-05-01147
2009: ENERGY AIR, INC. DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01167
Total number of active participants reported on line 7a of the Form 55002009-05-01173
Number of retired or separated participants receiving benefits2009-05-012
Number of other retired or separated participants entitled to future benefits2009-05-010
Total of all active and inactive participants2009-05-01175
2008: ENERGY AIR, INC. DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year2008-05-01157
Total number of active participants reported on line 7a of the Form 55002008-05-01167
Number of retired or separated participants receiving benefits2008-05-012
Number of other retired or separated participants entitled to future benefits2008-05-010
Total of all active and inactive participants2008-05-01169
2007: ENERGY AIR, INC. DENTAL PLAN 2007 401k membership
Total participants, beginning-of-year2007-05-01197
Total number of active participants reported on line 7a of the Form 55002007-05-01157
Number of retired or separated participants receiving benefits2007-05-010
Number of other retired or separated participants entitled to future benefits2007-05-010
Total of all active and inactive participants2007-05-01157
2006: ENERGY AIR, INC. DENTAL PLAN 2006 401k membership
Total participants, beginning-of-year2006-05-01167
Total number of active participants reported on line 7a of the Form 55002006-05-01197
Number of retired or separated participants receiving benefits2006-05-010
Number of other retired or separated participants entitled to future benefits2006-05-010
Total of all active and inactive participants2006-05-01197
2005: ENERGY AIR, INC. DENTAL PLAN 2005 401k membership
Total participants, beginning-of-year2005-05-01186
Total number of active participants reported on line 7a of the Form 55002005-05-01167
Number of retired or separated participants receiving benefits2005-05-010
Number of other retired or separated participants entitled to future benefits2005-05-010
Total of all active and inactive participants2005-05-01167
2004: ENERGY AIR, INC. DENTAL PLAN 2004 401k membership
Total participants, beginning-of-year2004-05-01138
Total number of active participants reported on line 7a of the Form 55002004-05-01186
Number of retired or separated participants receiving benefits2004-05-010
Number of other retired or separated participants entitled to future benefits2004-05-010
Total of all active and inactive participants2004-05-01186

Form 5500 Responses for ENERGY AIR, INC. DENTAL PLAN

2013: ENERGY AIR, INC. DENTAL PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingYes
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: ENERGY AIR, INC. DENTAL PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: ENERGY AIR, INC. DENTAL PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2010: ENERGY AIR, INC. DENTAL PLAN 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01Submission has been amendedNo
2010-05-01This submission is the final filingNo
2010-05-01This return/report is a short plan year return/report (less than 12 months)No
2010-05-01Plan is a collectively bargained planNo
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan benefit arrangement – InsuranceYes
2009: ENERGY AIR, INC. DENTAL PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes
2008: ENERGY AIR, INC. DENTAL PLAN 2008 form 5500 responses
2008-05-01Type of plan entitySingle employer plan
2008-05-01Submission has been amendedNo
2008-05-01This submission is the final filingNo
2008-05-01This return/report is a short plan year return/report (less than 12 months)No
2008-05-01Plan is a collectively bargained planNo
2008-05-01Plan funding arrangement – InsuranceYes
2008-05-01Plan benefit arrangement – InsuranceYes
2007: ENERGY AIR, INC. DENTAL PLAN 2007 form 5500 responses
2007-05-01Type of plan entitySingle employer plan
2007-05-01Submission has been amendedNo
2007-05-01This submission is the final filingNo
2007-05-01This return/report is a short plan year return/report (less than 12 months)No
2007-05-01Plan is a collectively bargained planNo
2007-05-01Plan funding arrangement – InsuranceYes
2007-05-01Plan benefit arrangement – InsuranceYes
2006: ENERGY AIR, INC. DENTAL PLAN 2006 form 5500 responses
2006-05-01Type of plan entitySingle employer plan
2006-05-01Submission has been amendedNo
2006-05-01This submission is the final filingNo
2006-05-01This return/report is a short plan year return/report (less than 12 months)No
2006-05-01Plan is a collectively bargained planNo
2006-05-01Plan funding arrangement – InsuranceYes
2006-05-01Plan benefit arrangement – InsuranceYes
2005: ENERGY AIR, INC. DENTAL PLAN 2005 form 5500 responses
2005-05-01Type of plan entitySingle employer plan
2005-05-01Submission has been amendedNo
2005-05-01This submission is the final filingNo
2005-05-01This return/report is a short plan year return/report (less than 12 months)No
2005-05-01Plan is a collectively bargained planNo
2005-05-01Plan funding arrangement – InsuranceYes
2005-05-01Plan benefit arrangement – InsuranceYes
2004: ENERGY AIR, INC. DENTAL PLAN 2004 form 5500 responses
2004-05-01Type of plan entitySingle employer plan
2004-05-01First time form 5500 has been submittedYes
2004-05-01Submission has been amendedNo
2004-05-01This submission is the final filingNo
2004-05-01This return/report is a short plan year return/report (less than 12 months)No
2004-05-01Plan is a collectively bargained planNo
2004-05-01Plan funding arrangement – InsuranceYes
2004-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3330725
Policy instance 1
Insurance contract or identification number3330725
Number of Individuals Covered170
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $4,846
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 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 $49,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,846
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC.
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3330725
Policy instance 1
Insurance contract or identification number3330725
Number of Individuals Covered139
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $4,170
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 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 $42,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,170
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3330725
Policy instance 1
Insurance contract or identification number3330725
Number of Individuals Covered130
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $5,084
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 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 $52,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,084
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3330725
Policy instance 1
Insurance contract or identification number3330725
Number of Individuals Covered205
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $5,167
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 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 $53,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,167
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3330725
Policy instance 1
Insurance contract or identification number3330725
Number of Individuals Covered190
Insurance policy start date2009-05-01
Insurance policy end date2010-04-30
Total amount of commissions paid to insurance brokerUSD $5,437
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 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 $55,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,437
Insurance broker organization code?3
Insurance broker nameBB&T INSURANCE SERVICES INC.
CIGNA DENTAL HEALTH OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 52021 )
Policy contract number3330725
Policy instance 1
Insurance contract or identification number3330725
Number of Individuals Covered171
Insurance policy start date2008-05-01
Insurance policy end date2009-04-30
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 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 $51,092
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00382152
Policy instance 1
Insurance contract or identification number00382152
Number of Individuals Covered221
Insurance policy start date2007-05-01
Insurance policy end date2008-04-30
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 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 $71,223
Commission paid to Insurance BrokerUSD $3,068
Amount paid for insurance broker fees5457
Additional information about fees paid to insurance brokerBONUS COMPENSATION
Insurance broker organization code?3
Insurance broker nameHARRISON-WATKINSON INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00382152
Policy instance 1
Insurance contract or identification number00382152
Number of Individuals Covered193
Insurance policy start date2006-05-01
Insurance policy end date2007-04-30
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 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 $78,333
Commission paid to Insurance BrokerUSD $3,175
Amount paid for insurance broker fees4773
Additional information about fees paid to insurance brokerSPECIAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHARRISON-WATKINSON INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00382152
Policy instance 1
Insurance contract or identification number00382152
Number of Individuals Covered233
Insurance policy start date2005-05-01
Insurance policy end date2006-04-30
Total amount of commissions paid to insurance brokerUSD $3,297
Total amount of fees paid to insurance companyUSD $4,155
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 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 $82,111
Commission paid to Insurance BrokerUSD $3,232
Amount paid for insurance broker fees4155
Additional information about fees paid to insurance brokerSPECIAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHARRISON-WATKINSON INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00382152
Policy instance 1
Insurance contract or identification number00382152
Number of Individuals Covered170
Insurance policy start date2004-05-01
Insurance policy end date2005-04-30
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 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 $59,828
Commission paid to Insurance BrokerUSD $2,897
Amount paid for insurance broker fees2857
Additional information about fees paid to insurance brokerSPECIAL PROVIDER COMPENSATION
Insurance broker organization code?3
Insurance broker nameJ. ROLFE DAVIS INSURANCE

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