BUDNEY INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC.
401k plan membership statisitcs for HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC.
| Measure | Date | Value |
|---|
| 2022: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 123 |
| Total of all active and inactive participants | 2022-07-01 | 123 |
| 2021: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 123 |
| Total of all active and inactive participants | 2021-07-01 | 123 |
| 2020: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 132 |
| Total of all active and inactive participants | 2020-07-01 | 132 |
| 2019: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 140 |
| Total of all active and inactive participants | 2019-07-01 | 140 |
| 2018: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 136 |
| Total of all active and inactive participants | 2018-07-01 | 136 |
| 2017: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 137 |
| Total of all active and inactive participants | 2017-07-01 | 137 |
| 2016: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 131 |
| Total of all active and inactive participants | 2016-07-01 | 131 |
| 2015: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 124 |
| Total of all active and inactive participants | 2015-07-01 | 124 |
| 2014: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 122 |
| Total of all active and inactive participants | 2014-07-01 | 122 |
| 2013: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 127 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-07-01 | 0 |
| Total of all active and inactive participants | 2013-07-01 | 127 |
| 2012: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 128 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 0 |
| Total of all active and inactive participants | 2012-07-01 | 128 |
| 2011: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 133 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
| Total of all active and inactive participants | 2011-07-01 | 133 |
| 2010: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 138 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 0 |
| Total of all active and inactive participants | 2010-07-01 | 138 |
| 2009: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 140 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
| Total of all active and inactive participants | 2009-07-01 | 140 |
| 2022: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2022 form 5500 responses |
|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: HEALTH & WELFARE BENEFIT PLANS OF BUDNEY INDUSTRIES, INC. 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CM10000245 |
| Policy instance | 2 |
| Insurance contract or identification number | CM10000245 | | Number of Individuals Covered | 123 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $2,399 | | Total amount of fees paid to insurance company | USD $942 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $25,961 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,399 | | Amount paid for insurance broker fees | 942 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 ) |
| Policy contract number | L00782 |
| Policy instance | 1 |
| Insurance contract or identification number | L00782 | | Number of Individuals Covered | 101 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $2,382 | | Total amount of fees paid to insurance company | USD $404 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,382 | | Amount paid for insurance broker fees | 133 | | Insurance broker organization code? | 3 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CM10000245 |
| Policy instance | 2 |
| Insurance contract or identification number | CM10000245 | | Number of Individuals Covered | 123 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $2,386 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $21,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,004 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 ) |
| Policy contract number | L00782 |
| Policy instance | 1 |
| Insurance contract or identification number | L00782 | | Number of Individuals Covered | 101 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $5,096 | | Total amount of fees paid to insurance company | USD $260 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,684 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CM10000245 |
| Policy instance | 2 |
| Insurance contract or identification number | CM10000245 | | Number of Individuals Covered | 132 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $2,254 | | Total amount of fees paid to insurance company | USD $136 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $24,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 ) |
| Policy contract number | L00782 |
| Policy instance | 1 |
| Insurance contract or identification number | L00782 | | Number of Individuals Covered | 103 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $4,400 | | Total amount of fees paid to insurance company | USD $884 | | Dental Insurance Welfare Benefit | Yes | | 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 | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 113 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $2,181 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,181 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804647G |
| Policy instance | 2 |
| Insurance contract or identification number | 804647G | | Number of Individuals Covered | 140 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $3,037 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $24,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,037 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 136 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $2,910 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $25,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,910 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 118 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $2,273 | | Total amount of fees paid to insurance company | USD $684 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,273 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 684 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 137 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $2,830 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $25,092 | | 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 | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 117 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $2,256 | | Total amount of fees paid to insurance company | USD $640 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 124 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $2,171 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,171 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS & KAUTMAR |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 105 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $2,048 | | Total amount of fees paid to insurance company | USD $332 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,048 | | Amount paid for insurance broker fees | 332 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS, INC. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 122 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $2,169 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,169 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS & KAUTMAR |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 107 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $2,130 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,130 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 112 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $2,092 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,092 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS, INC. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 127 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $1,858 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,858 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS & KAUTMAR |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 128 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $2,031 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,031 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS & KAUTMAR |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 114 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $2,191 | | Total amount of fees paid to insurance company | USD $567 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,191 | | Amount paid for insurance broker fees | 567 | | Insurance broker organization code? | 3 | | Insurance broker name | WENTWORTH-DEANGELIS, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 116 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $2,487 | | Total amount of fees paid to insurance company | USD $509 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 133 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $1,699 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00371518 |
| Policy instance | 1 |
| Insurance contract or identification number | 00371518 | | Number of Individuals Covered | 127 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $2,247 | | Total amount of fees paid to insurance company | USD $414 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $8,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 308735 |
| Policy instance | 2 |
| Insurance contract or identification number | 308735 | | Number of Individuals Covered | 138 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $1,844 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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