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GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 401k Plan overview

Plan NameGURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN
Plan identification number 511

GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

GURWIN JEWISH NURSING & REHABILITATION CENTER has sponsored the creation of one or more 401k plans.

Company Name:GURWIN JEWISH NURSING & REHABILITATION CENTER
Employer identification number (EIN):112785201
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5112014-12-01PATRICK DONNELLAN STACIE CAPLAN2016-01-08
5112013-12-01PATRICK DONNELLAN STACIE CAPLAN2015-12-19
5112012-12-01PATRICK DONNELLAN STACIE CAPLAN2015-12-19
5112011-12-01PATRICK DONNELLAN STACIE CAPLAN2016-02-12
5112010-12-01PATRICK DONNELLAN STACIE CAPLAN2016-02-12
5112009-12-01PATRICK DONNELLAN STACIE CAPLAN2016-02-12
5112008-12-01PATRICK DONNELLAN STACIE CAPLAN2016-02-12
5112007-12-01PATRICK DONNELLAN STACIE CAPLAN2016-02-12
5112006-12-01PATRICK DONNELLAN STACIE CAPLAN2016-02-12

Plan Statistics for GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN

401k plan membership statisitcs for GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN

Measure Date Value
2014: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01929
Total number of active participants reported on line 7a of the Form 55002014-12-010
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-010
Total of all active and inactive participants2014-12-010
2013: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01926
Total number of active participants reported on line 7a of the Form 55002013-12-01929
Number of retired or separated participants receiving benefits2013-12-010
Number of other retired or separated participants entitled to future benefits2013-12-010
Total of all active and inactive participants2013-12-01929
2012: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-01895
Total number of active participants reported on line 7a of the Form 55002012-12-01926
Number of retired or separated participants receiving benefits2012-12-010
Number of other retired or separated participants entitled to future benefits2012-12-010
Total of all active and inactive participants2012-12-01926
2011: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01910
Total number of active participants reported on line 7a of the Form 55002011-12-01895
Number of retired or separated participants receiving benefits2011-12-010
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-01895
2010: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-12-01912
Total number of active participants reported on line 7a of the Form 55002010-12-01910
Number of retired or separated participants receiving benefits2010-12-010
Number of other retired or separated participants entitled to future benefits2010-12-010
Total of all active and inactive participants2010-12-01910
2009: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01897
Total number of active participants reported on line 7a of the Form 55002009-12-01912
Number of retired or separated participants receiving benefits2009-12-010
Number of other retired or separated participants entitled to future benefits2009-12-010
Total of all active and inactive participants2009-12-01912
2008: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2008 401k membership
Total participants, beginning-of-year2008-12-01856
Total number of active participants reported on line 7a of the Form 55002008-12-01897
Number of retired or separated participants receiving benefits2008-12-010
Number of other retired or separated participants entitled to future benefits2008-12-010
Total of all active and inactive participants2008-12-01897
2007: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2007 401k membership
Total participants, beginning-of-year2007-12-01840
Total number of active participants reported on line 7a of the Form 55002007-12-01856
Number of retired or separated participants receiving benefits2007-12-010
Number of other retired or separated participants entitled to future benefits2007-12-010
Total of all active and inactive participants2007-12-01856
2006: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2006 401k membership
Total participants, beginning-of-year2006-12-01835
Total number of active participants reported on line 7a of the Form 55002006-12-01840
Number of retired or separated participants receiving benefits2006-12-010
Number of other retired or separated participants entitled to future benefits2006-12-010
Total of all active and inactive participants2006-12-01840

Form 5500 Responses for GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN

2014: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingYes
2014-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – General assets of the sponsorYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement – General assets of the sponsorYes
2013: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan benefit arrangement – InsuranceYes
2012: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan benefit arrangement – InsuranceYes
2011: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan benefit arrangement – InsuranceYes
2010: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2010 form 5500 responses
2010-12-01Type of plan entitySingle employer plan
2010-12-01Submission has been amendedNo
2010-12-01This submission is the final filingNo
2010-12-01This return/report is a short plan year return/report (less than 12 months)No
2010-12-01Plan is a collectively bargained planNo
2010-12-01Plan funding arrangement – InsuranceYes
2010-12-01Plan benefit arrangement – InsuranceYes
2009: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan benefit arrangement – InsuranceYes
2008: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2008 form 5500 responses
2008-12-01Type of plan entitySingle employer plan
2008-12-01Submission has been amendedNo
2008-12-01This submission is the final filingNo
2008-12-01This return/report is a short plan year return/report (less than 12 months)No
2008-12-01Plan is a collectively bargained planNo
2008-12-01Plan funding arrangement – InsuranceYes
2008-12-01Plan benefit arrangement – InsuranceYes
2007: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2007 form 5500 responses
2007-12-01Type of plan entitySingle employer plan
2007-12-01Submission has been amendedNo
2007-12-01This submission is the final filingNo
2007-12-01This return/report is a short plan year return/report (less than 12 months)No
2007-12-01Plan is a collectively bargained planNo
2007-12-01Plan funding arrangement – InsuranceYes
2007-12-01Plan benefit arrangement – InsuranceYes
2006: GURWIN JEWISH GERIATRIC CENTER ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN 2006 form 5500 responses
2006-12-01Type of plan entitySingle employer plan
2006-12-01Submission has been amendedNo
2006-12-01This submission is the final filingNo
2006-12-01This return/report is a short plan year return/report (less than 12 months)No
2006-12-01Plan is a collectively bargained planNo
2006-12-01Plan funding arrangement – InsuranceYes
2006-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered929
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $3,645
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $11,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,909
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered926
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $3,588
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $11,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,795
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered895
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $3,913
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $12,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,093
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered910
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $3,874
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $11,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,163
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered912
Insurance policy start date2009-12-01
Insurance policy end date2010-11-30
Total amount of commissions paid to insurance brokerUSD $4,222
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $12,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,358
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered897
Insurance policy start date2008-12-01
Insurance policy end date2009-11-30
Total amount of commissions paid to insurance brokerUSD $3,795
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $12,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,988
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered856
Insurance policy start date2007-12-01
Insurance policy end date2008-11-30
Total amount of commissions paid to insurance brokerUSD $3,524
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $11,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,762
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6477-13-12
Policy instance 1
Insurance contract or identification number6477-13-12
Number of Individuals Covered840
Insurance policy start date2006-12-01
Insurance policy end date2007-11-30
Total amount of commissions paid to insurance brokerUSD $3,396
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $11,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,698
Insurance broker organization code?3
Insurance broker namePERLOW PLANNING COMPANY, INC.

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