QUALITY RESTAURANT CONCEPTS, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.)
401k plan membership statisitcs for WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.)
| Measure | Date | Value |
|---|
| 2020: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 512 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 0 |
| 2019: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 444 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 512 |
| Total of all active and inactive participants | 2019-05-01 | 512 |
| Total participants | 2019-05-01 | 512 |
| 2018: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 483 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 444 |
| Total of all active and inactive participants | 2018-05-01 | 444 |
| Total participants | 2018-05-01 | 444 |
| 2017: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 452 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 483 |
| Total of all active and inactive participants | 2017-05-01 | 483 |
| Total participants | 2017-05-01 | 483 |
| 2016: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 525 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 452 |
| Total of all active and inactive participants | 2016-05-01 | 452 |
| Total participants | 2016-05-01 | 452 |
| 2015: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 600 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 525 |
| Total of all active and inactive participants | 2015-05-01 | 525 |
| Total participants | 2015-05-01 | 525 |
| 2014: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 620 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 600 |
| Total of all active and inactive participants | 2014-05-01 | 600 |
| Total participants | 2014-05-01 | 600 |
| 2013: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 600 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 620 |
| Total of all active and inactive participants | 2013-05-01 | 620 |
| Total participants | 2013-05-01 | 620 |
| 2012: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 650 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 600 |
| Total of all active and inactive participants | 2012-05-01 | 600 |
| Total participants | 2012-05-01 | 600 |
| 2011: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 680 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 650 |
| Total of all active and inactive participants | 2011-05-01 | 650 |
| Total participants | 2011-05-01 | 650 |
| 2009: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 750 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 700 |
| Total of all active and inactive participants | 2009-05-01 | 700 |
| Total participants | 2009-05-01 | 700 |
| 2020: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | This submission is the final filing | Yes |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Plan funding arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Submission has been amended | Yes |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: WELFARE PLAN FOR EMPLOYEES OF APPLE OF NORTH ALABAMA, INC. (QUALITY RESTAURANT CONCEPTS, L.L.C.) 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 1 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,734 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,048 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,705 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5471979 |
| Policy instance | 2 |
| Insurance contract or identification number | 5471979 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $2,590 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,267 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,590 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | AM0970 |
| Policy instance | 3 |
| Insurance contract or identification number | AM0970 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $6,381 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,117 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | AM0970 |
| Policy instance | 3 |
| Insurance contract or identification number | AM0970 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,834 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,764 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5471979 |
| Policy instance | 2 |
| Insurance contract or identification number | 5471979 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $5,237 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,237 | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 1 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $12,401 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,086 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5471979 |
| Policy instance | 2 |
| Insurance contract or identification number | 5471979 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $5,391 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,951 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,391 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 1 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $13,062 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,464 | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE INSURANCE BENEFITS |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | AM0970 |
| Policy instance | 3 |
| Insurance contract or identification number | AM0970 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $6,336 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,879 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,088 | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE INSURANCE BENEFITS |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 1 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $26,177 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $152,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,470 | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE INSURANCE BENEFITS |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5471979 |
| Policy instance | 2 |
| Insurance contract or identification number | 5471979 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $5,433 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,433 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5471979 |
| Policy instance | 3 |
| Insurance contract or identification number | 5471979 | | Number of Individuals Covered | 242 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $5,748 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,748 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 2 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 600 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $29,621 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $172,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,205 | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE INSURANCE BENEFITS |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00399981 |
| Policy instance | 1 |
| Insurance contract or identification number | 00399981 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,322 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 2 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 620 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $28,798 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $166,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,982 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD HOLMES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00399981 |
| Policy instance | 1 |
| Insurance contract or identification number | 00399981 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $40,529 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $167,550 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,529 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00399981 |
| Policy instance | 1 |
| Insurance contract or identification number | 00399981 | | Number of Individuals Covered | 268 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $26,212 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $159,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,503 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN R. GRIFFIN |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 2 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 600 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $22,638 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $129,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,170 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD HOLMES |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 2 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 650 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $31,261 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $160,593 | | 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 | 00399981 |
| Policy instance | 1 |
| Insurance contract or identification number | 00399981 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $20,006 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $160,592 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FV0970 |
| Policy instance | 2 |
| Insurance contract or identification number | FV0970 | | Number of Individuals Covered | 680 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $34,141 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $163,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,606 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD HOLMES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00399981 |
| Policy instance | 1 |
| Insurance contract or identification number | 00399981 | | Number of Individuals Covered | 273 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $19,785 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $158,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,038 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN R. GRIFFIN |
|
