401k Plan data: TETON OUTFITTERS FORM 5500 plan

TETON OUTFITTERS FORM 5500 401k Plan overview

Plan Name	TETON OUTFITTERS FORM 5500
Plan identification number	503

TETON OUTFITTERS FORM 5500 Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Supplemental unemployment Dental Vision

401k Sponsoring company profile

TETON OUTFITTERS has sponsored the creation of one or more 401k plans.

Company Name: TETON OUTFITTERS

Employer identification number (EIN): 820504432

NAIC Classification: 423920
NAIC Description: Toy and Hobby Goods and Supplies Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TETON OUTFITTERS FORM 5500

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-01-01 TONY CHAVEZ 2022-06-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2021-01-01	TONY CHAVEZ	2022-06-28

Plan Statistics for TETON OUTFITTERS FORM 5500

401k plan membership statisitcs for TETON OUTFITTERS FORM 5500

Measure Date Value
2021: TETON OUTFITTERS FORM 5500 2021 401k membership
Total participants, beginning-of-year 2021-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 123
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 123

Measure	Date	Value
2021: TETON OUTFITTERS FORM 5500 2021 401k membership
Total participants, beginning-of-year	2021-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	123
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	123

Form 5500 Responses for TETON OUTFITTERS FORM 5500

2021: TETON OUTFITTERS FORM 5500 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00546550

Policy instance

Insurance contract or identification number	00546550
Number of Individuals Covered	123
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,576
Total amount of fees paid to insurance company	USD $162
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	SHORT TERM DISABILITY, AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $46,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,788
Amount paid for insurance broker fees	162
Additional information about fees paid to insurance broker	SPECIAL PRODUCER COMPENSATION
Insurance broker organization code?	3

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Company Name:	TETON OUTFITTERS
Employer identification number (EIN):	820504432
NAIC Classification:	423920
NAIC Description:	Toy and Hobby Goods and Supplies Merchant Wholesalers