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PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 401k Plan overview

Plan NamePHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN
Plan identification number 501

PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

PHILLIPS INFRASTRUCTURE HLDGS, INC has sponsored the creation of one or more 401k plans.

Company Name:PHILLIPS INFRASTRUCTURE HLDGS, INC
Employer identification number (EIN):823206761
NAIC Classification:237990
NAIC Description:Other Heavy and Civil Engineering Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01

Plan Statistics for PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN

401k plan membership statisitcs for PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN

Measure Date Value
2022: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,446
Total number of active participants reported on line 7a of the Form 55002022-01-011,409
Number of retired or separated participants receiving benefits2022-01-017
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-011,416
2021: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,446
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
2020: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,382
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-010
2019: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,444
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
2018: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,237
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010

Financial Data on PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN

Measure Date Value
2022 : PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$471,778
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,020,755
Total income from all sources (including contributions)2022-12-31$11,883,992
Total of all expenses incurred2022-12-31$11,975,773
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$11,971,787
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$11,883,992
Value of total assets at end of year2022-12-31$1,091,262
Value of total assets at beginning of year2022-12-31$1,732,020
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$3,986
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31No
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$3,885,516
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$401,920
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$889,363
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$471,778
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$1,020,755
Administrative expenses (other) incurred2022-12-31$3,986
Total non interest bearing cash at end of year2022-12-31$689,342
Total non interest bearing cash at beginning of year2022-12-31$842,657
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-91,781
Value of net assets at end of year (total assets less liabilities)2022-12-31$619,484
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$711,265
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$3,527,499
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$7,998,476
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$8,444,288
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31RODEFER MOSS & CO, PLLC
Accountancy firm EIN2022-12-31621690032
2021 : PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,020,755
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$480,918
Total income from all sources (including contributions)2021-12-31$11,148,901
Total of all expenses incurred2021-12-31$11,042,119
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$11,010,471
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$11,148,901
Value of total assets at end of year2021-12-31$1,732,020
Value of total assets at beginning of year2021-12-31$1,085,401
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$31,648
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31No
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$3,631,070
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$889,363
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$543,248
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$1,020,755
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$480,918
Administrative expenses (other) incurred2021-12-31$31,648
Total non interest bearing cash at end of year2021-12-31$842,657
Total non interest bearing cash at beginning of year2021-12-31$542,153
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$106,782
Value of net assets at end of year (total assets less liabilities)2021-12-31$711,265
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$604,483
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$3,323,650
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$7,517,831
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$7,686,821
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31RODEFER MOSS & CO, PLLC
Accountancy firm EIN2021-12-31621690032
2020 : PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$480,918
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$314,515
Total income from all sources (including contributions)2020-12-31$10,575,891
Total of all expenses incurred2020-12-31$10,677,762
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$9,414,102
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$10,575,891
Value of total assets at end of year2020-12-31$1,085,401
Value of total assets at beginning of year2020-12-31$1,020,869
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$1,263,660
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31No
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$3,652,487
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$543,248
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$262,316
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$480,918
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$314,515
Administrative expenses (other) incurred2020-12-31$1,263,660
Total non interest bearing cash at end of year2020-12-31$542,153
Total non interest bearing cash at beginning of year2020-12-31$758,553
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-101,871
Value of net assets at end of year (total assets less liabilities)2020-12-31$604,483
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$706,354
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$1,002,169
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$6,923,404
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$8,411,933
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31RODEFER MOSS & CO, PLLC
Accountancy firm EIN2020-12-31621690032
2019 : PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$314,515
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$282,100
Total income from all sources (including contributions)2019-12-31$10,031,322
Total of all expenses incurred2019-12-31$9,864,173
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$8,680,598
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$10,031,322
Value of total assets at end of year2019-12-31$1,020,869
Value of total assets at beginning of year2019-12-31$821,305
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$1,183,575
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$5,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$3,416,575
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$262,316
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$116,543
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$314,515
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$282,100
Administrative expenses (other) incurred2019-12-31$1,183,575
Total non interest bearing cash at end of year2019-12-31$758,553
Total non interest bearing cash at beginning of year2019-12-31$704,762
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$167,149
Value of net assets at end of year (total assets less liabilities)2019-12-31$706,354
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$539,205
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$793,507
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$6,614,747
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$7,887,091
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31RODEFER MOSS & CO, PLLC
Accountancy firm EIN2019-12-31621690032
2018 : PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2018 401k financial data
Total transfer of assets to this plan2018-12-31$516,643
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$282,100
Total income from all sources (including contributions)2018-12-31$8,768,374
Total of all expenses incurred2018-12-31$8,745,812
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$8,169,598
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$8,768,374
Value of total assets at end of year2018-12-31$821,305
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$576,214
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$5,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$2,765,387
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$116,543
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$282,100
Administrative expenses (other) incurred2018-12-31$576,214
Total non interest bearing cash at end of year2018-12-31$704,762
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$22,562
Value of net assets at end of year (total assets less liabilities)2018-12-31$539,205
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$599,682
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$6,002,987
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$7,569,916
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31RODEFER MOSS & CO, PLLC
Accountancy firm EIN2018-12-31621690032

Form 5500 Responses for PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN

2022: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: PHILLIPS INFRASTRUCTURE HLDGS, INC. HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3332287
Policy instance 1
Insurance contract or identification number3332287
Number of Individuals Covered1409
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,478
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,747,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,478
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00534925
Policy instance 2
Insurance contract or identification number00534925
Number of Individuals Covered1095
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $123,429
Total amount of fees paid to insurance companyUSD $22,496
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $969,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $123,429
Amount paid for insurance broker fees22496
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3332287
Policy instance 1
Insurance contract or identification number3332287
Number of Individuals Covered1446
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,680
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,328,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,685
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00534925
Policy instance 2
Insurance contract or identification number00534925
Number of Individuals Covered957
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $85,161
Total amount of fees paid to insurance companyUSD $19,093
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $673,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $85,161
Amount paid for insurance broker fees19093
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3332287
Policy instance 1
Insurance contract or identification number3332287
Number of Individuals Covered1382
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,356
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,096,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,356
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00534925
Policy instance 2
Insurance contract or identification number00534925
Number of Individuals Covered948
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $92,795
Total amount of fees paid to insurance companyUSD $16,450
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $673,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,795
Amount paid for insurance broker fees16450
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3332287
Policy instance 1
Insurance contract or identification number3332287
Number of Individuals Covered1444
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $7,647
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $876,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,647
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00534925
Policy instance 2
Insurance contract or identification number00534925
Number of Individuals Covered1021
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $90,446
Total amount of fees paid to insurance companyUSD $15,836
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $655,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $90,446
Amount paid for insurance broker fees15836
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3332287
Policy instance 1
Insurance contract or identification number3332287
Number of Individuals Covered1237
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,797
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $688,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,797
Insurance broker organization code?3

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