GOODWILL INDUSTRIES OF TULSA, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC.
401k plan membership statisitcs for EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC.
| Measure | Date | Value |
|---|
| 2021: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 159 |
| Number of retired or separated participants receiving benefits | 2021-10-01 | 1 |
| Total of all active and inactive participants | 2021-10-01 | 160 |
| Total participants | 2021-10-01 | 160 |
| 2020: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 199 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 1 |
| Total of all active and inactive participants | 2020-10-01 | 200 |
| Total participants | 2020-10-01 | 200 |
| 2019: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 215 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 204 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 1 |
| Total of all active and inactive participants | 2019-10-01 | 205 |
| Total participants | 2019-10-01 | 205 |
| 2018: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 196 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 4 |
| Total of all active and inactive participants | 2018-10-01 | 200 |
| Total participants | 2018-10-01 | 200 |
| 2017: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 238 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 214 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 217 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-10-01 | 0 |
| Total participants | 2017-10-01 | 217 |
| Number of participants with account balances | 2017-10-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-10-01 | 0 |
| Number of employers contributing to the scheme | 2017-10-01 | 0 |
| 2016: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 247 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 244 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 6 |
| Total of all active and inactive participants | 2016-10-01 | 250 |
| Total participants | 2016-10-01 | 250 |
| 2015: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 243 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 256 |
| Total of all active and inactive participants | 2015-10-01 | 256 |
| Total participants | 2015-10-01 | 256 |
| 2014: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 242 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
| Total of all active and inactive participants | 2014-10-01 | 243 |
| Total participants | 2014-10-01 | 243 |
| 2012: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 222 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 252 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 3 |
| Total of all active and inactive participants | 2012-10-01 | 255 |
| Total participants | 2012-10-01 | 255 |
| 2011: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 222 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
| Total of all active and inactive participants | 2011-10-01 | 222 |
| Total participants | 2011-10-01 | 222 |
| 2010: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 181 |
| Number of retired or separated participants receiving benefits | 2010-10-01 | 0 |
| Total of all active and inactive participants | 2010-10-01 | 181 |
| Total participants | 2010-10-01 | 181 |
| 2009: EMPLOYEE FRINGE BENEFIT PLAN OF GOODWILL INDUSTRIES OF TULSA, INC. 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 155 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 4 |
| Total of all active and inactive participants | 2009-10-01 | 159 |
| Total participants | 2009-10-01 | 159 |
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 5 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of fees paid to insurance company | USD $62,755 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,232,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 62755 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 31737 |
| Policy instance | 4 |
| Insurance contract or identification number | 31737 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $4,004 | | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $20,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,004 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $2,041 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,041 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $8,420 | | Total amount of fees paid to insurance company | USD $26 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,420 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 26 | | Additional information about fees paid to insurance broker | TPA FEES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $4,454 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,766 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,454 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $4,860 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,425 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,860 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $9,305 | | Total amount of fees paid to insurance company | USD $39 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $56,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,305 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 39 | | Additional information about fees paid to insurance broker | TPA FEES |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1,620 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $109 | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 5 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of fees paid to insurance company | USD $76,160 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,459,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 76160 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 31737 |
| Policy instance | 4 |
| Insurance contract or identification number | 31737 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $3,892 | | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $23,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,892 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $5,054 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $98,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,054 | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 5 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of fees paid to insurance company | USD $82,005 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,572,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 82005 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $9,674 | | Total amount of fees paid to insurance company | USD $54 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,573 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,674 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 26 | | Additional information about fees paid to insurance broker | TPA FEES |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,617 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,617 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 31737 |
| Policy instance | 4 |
| Insurance contract or identification number | 31737 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $5,409 | | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $39,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,409 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 0002B375 |
| Policy instance | 1 |
| Insurance contract or identification number | 0002B375 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $5,129 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,129 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,677 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,677 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $9,489 | | Total amount of fees paid to insurance company | USD $77 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $58,437 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,489 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 77 | | Additional information about fees paid to insurance broker | TPA FEES |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 31737 |
| Policy instance | 4 |
| Insurance contract or identification number | 31737 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $6,937 | | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $24,437 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,937 | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 5 |
| Insurance contract or identification number | 86509 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-05-30 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Total amount of fees paid to insurance company | USD $79,660 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,620,240 | | Amount paid for insurance broker fees | 79660 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 5 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of fees paid to insurance company | USD $79,905 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,679,337 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 31737 |
| Policy instance | 4 |
| Insurance contract or identification number | 31737 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $14,544 | | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $22,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $12,848 | | Total amount of fees paid to insurance company | USD $95 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $61,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,573 | | Total amount of fees paid to insurance company | USD $89 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,490 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 0002B375 |
| Policy instance | 1 |
| Insurance contract or identification number | 0002B375 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $5,196 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $105,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $5,034 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,022 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,034 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $11,953 | | Total amount of fees paid to insurance company | USD $88 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SHORT TERM DISABILITY, ADD | | Welfare Benefit Premiums Paid to Carrier | USD $113,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,749 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 88 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Insurance broker name | AXA ASSISTANCE, USA |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 4 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $74,865 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,531,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $74,865 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,663 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,663 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $4,435 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Welfare Benefit Premiums Paid to Carrier | USD $93,346 | | Commission paid to Insurance Broker | USD $4,931 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP |
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of fees paid to insurance company | USD $5,242 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | STD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Total amount of commissions paid to insurance broker | USD $8,884 | | Welfare Benefit Premiums Paid to Carrier | USD $109,076 | | Commission paid to Insurance Broker | USD $8,884 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 86 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker name | AXA ASSISTANCE USA |
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| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 3 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $49,454 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,402 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,402 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 4 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $62,300 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,364,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $62,300 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | 12882 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $8,814 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $105,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,733 | | Insurance broker organization code? | 3 | | Insurance broker name | AXA ASSISTANCE, USA |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | C10214 |
| Policy instance | 3 |
| Insurance contract or identification number | C10214 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $56,812 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,109,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,812 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP, INC. |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $4,435 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,435 | | Insurance broker organization code? | 3 | | Insurance broker name | SUMMIT FINANCIAL GROUP, INC. |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | 221018 |
| Policy instance | 4 |
| Insurance contract or identification number | 221018 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $47,952 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $992,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | IC0J19 |
| Policy instance | 3 |
| Insurance contract or identification number | IC0J19 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $2,499 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,313 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $4,176 | | Total amount of fees paid to insurance company | USD $1,276 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 12882 |
| Policy instance | 2 |
| Insurance contract or identification number | CR13823 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,277 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,277 | | Insurance broker organization code? | 4 | | Other welfare benefits provided | STD | | Welfare Benefit Premiums Paid to Carrier | USD $96,244 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00417151 |
| Policy instance | 1 |
| Insurance contract or identification number | 00417151 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $4,415 | | Total amount of fees paid to insurance company | USD $1,979 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 2 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $2,708 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 638019 |
| Policy instance | 3 |
| Insurance contract or identification number | 638019 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $1,272 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITYCARE (National Association of Insurance Commissioners NAIC id number: 89008 ) |
| Policy contract number | IC0J19 |
| Policy instance | 4 |
| Insurance contract or identification number | IC0J19 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $2,197 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,742 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 ) |
| Policy contract number | 221018 |
| Policy instance | 5 |
| Insurance contract or identification number | 221018 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $46,612 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $978,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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