ROSE-HULMAN INSTITUTE OF TECHNOLOGY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 503 | 2022-08-01 | | | | |
| 503 | 2021-08-01 | | | | |
| 503 | 2020-08-01 | | | | |
| 503 | 2019-08-01 | | | | |
| 503 | 2018-08-01 | | | | |
| 503 | 2017-08-01 | | | | |
| 503 | 2016-08-01 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2018-05-15 |
| 503 | 2015-08-01 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2017-05-12 |
| 503 | 2014-08-01 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2016-04-04 |
| 503 | 2013-08-01 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2015-04-13 |
| 503 | 2012-08-01 | MATTHEW D. DAVIS, VP FOR FINANCE | | MATTHEW D. DAVIS, VP FOR FINANCE | 2014-02-27 |
| 503 | 2011-08-01 | MATTHEW D. DAVIS, VP FOR FINANCE | | MATHHEW D. DAVIS, VP FOR FINANCE | 2013-05-31 |
| 503 | 2009-08-01 | ROBERT A. COONS, CAO | | ROBERT A. COONS, CAO | 2011-02-25 |
401k plan membership statisitcs for GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY
| Measure | Date | Value |
|---|
| 2022: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-08-01 | 455 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 457 |
| Number of retired or separated participants receiving benefits | 2022-08-01 | 0 |
| Total of all active and inactive participants | 2022-08-01 | 457 |
| Total participants | 2022-08-01 | 457 |
| 2021: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 478 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 455 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
| Total of all active and inactive participants | 2021-08-01 | 455 |
| Total participants | 2021-08-01 | 455 |
| 2020: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 486 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 477 |
| Number of retired or separated participants receiving benefits | 2020-08-01 | 1 |
| Total of all active and inactive participants | 2020-08-01 | 478 |
| Total participants | 2020-08-01 | 478 |
| 2019: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 546 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 486 |
| Number of retired or separated participants receiving benefits | 2019-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
| Total of all active and inactive participants | 2019-08-01 | 486 |
| Total participants | 2019-08-01 | 486 |
| 2018: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 513 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 538 |
| Number of retired or separated participants receiving benefits | 2018-08-01 | 8 |
| Total of all active and inactive participants | 2018-08-01 | 546 |
| Total participants | 2018-08-01 | 546 |
| 2017: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 503 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 506 |
| Number of retired or separated participants receiving benefits | 2017-08-01 | 7 |
| Total of all active and inactive participants | 2017-08-01 | 513 |
| 2016: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 482 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 503 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 7 |
| Total of all active and inactive participants | 2016-08-01 | 510 |
| 2015: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 468 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 475 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 7 |
| Total of all active and inactive participants | 2015-08-01 | 482 |
| 2014: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 454 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 462 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 6 |
| Total of all active and inactive participants | 2014-08-01 | 468 |
| 2013: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 444 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 449 |
| Number of retired or separated participants receiving benefits | 2013-08-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2013-08-01 | 0 |
| Total of all active and inactive participants | 2013-08-01 | 454 |
| 2012: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 415 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 439 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 5 |
| Total of all active and inactive participants | 2012-08-01 | 444 |
| 2011: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 414 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 412 |
| Number of retired or separated participants receiving benefits | 2011-08-01 | 3 |
| Total of all active and inactive participants | 2011-08-01 | 415 |
| 2009: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 420 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 410 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2009-08-01 | 0 |
| Total of all active and inactive participants | 2009-08-01 | 414 |
| Measure | Date | Value |
|---|
| 2011 : GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2011 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-07-31 | No |
| Was this plan covered by a fidelity bond | 2011-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2011-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-07-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-07-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-07-31 | No |
| Did the plan have assets held for investment | 2011-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-07-31 | No |
| 2022: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2022 form 5500 responses |
|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Submission has been amended | No |
| 2022-08-01 | This submission is the final filing | No |
| 2022-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-08-01 | Plan is a collectively bargained plan | No |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Submission has been amended | No |
| 2021-08-01 | This submission is the final filing | No |
| 2021-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-08-01 | Plan is a collectively bargained plan | No |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Submission has been amended | No |
| 2020-08-01 | This submission is the final filing | No |
| 2020-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-08-01 | Plan is a collectively bargained plan | No |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Submission has been amended | No |
| 2019-08-01 | This submission is the final filing | No |
| 2019-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-08-01 | Plan is a collectively bargained plan | No |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Submission has been amended | No |
| 2018-08-01 | This submission is the final filing | No |
| 2018-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-08-01 | Plan is a collectively bargained plan | No |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GROUP LONG-TERM DISABILITY BENEFIT PLAN FOR ROSE-HULMAN INSTITUTE OF TECHNOLOGY 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 457 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $14,959 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $99,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,959 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 455 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $1,269 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $8,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,269 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00010262140 |
| Policy instance | 1 |
| Insurance contract or identification number | 00010262140 | | Number of Individuals Covered | 460 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $15,975 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $106,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,975 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00010262140 |
| Policy instance | 1 |
| Insurance contract or identification number | 00010262140 | | Number of Individuals Covered | 477 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $19,266 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $128,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,266 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00010262140 |
| Policy instance | 2 |
| Insurance contract or identification number | 00010262140 | | Number of Individuals Covered | 486 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $1,594 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $10,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,594 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00529991 |
| Policy instance | 1 |
| Insurance contract or identification number | 00529991 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $20,212 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $134,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,212 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00529991 |
| Policy instance | 2 |
| Insurance contract or identification number | 00529991 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $18,300 | | Total amount of fees paid to insurance company | USD $0 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $122,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,300 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00529991 |
| Policy instance | 2 |
| Insurance contract or identification number | 00529991 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $21,791 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $145,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 201998 |
| Policy instance | 1 |
| Insurance contract or identification number | 201998 | | Number of Individuals Covered | 459 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $14,939 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $149,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,939 | | Insurance broker organization code? | 3 | | Insurance broker name | SHEPHERD INSURANCE LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 201998 |
| Policy instance | 1 |
| Insurance contract or identification number | 201998 | | Number of Individuals Covered | 446 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $13,980 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $139,795 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,980 | | Insurance broker organization code? | 3 | | Insurance broker name | SHEPHERD INSURANCE LLC |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 201998 |
| Policy instance | 1 |
| Insurance contract or identification number | 201998 | | Number of Individuals Covered | 439 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $13,256 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $132,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,114 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | SHEPHERD INSURANCE LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 201998 |
| Policy instance | 1 |
| Insurance contract or identification number | 201998 | | Number of Individuals Covered | 412 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $12,609 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $126,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 201998 |
| Policy instance | 1 |
| Insurance contract or identification number | 201998 | | Number of Individuals Covered | 414 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $12,334 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $123,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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