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COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 401k Plan overview

Plan NameCOMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN
Plan identification number 502

COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

COMMUNITY SUPPORT SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY SUPPORT SERVICES, INC.
Employer identification number (EIN):237029146
NAIC Classification:621420
NAIC Description:Outpatient Mental Health and Substance Abuse Centers

Additional information about COMMUNITY SUPPORT SERVICES, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1969-01-22
Company Identification Number: 379859
Legal Registered Office Address: 150 CROSS STREET
-
AKRON
United States of America (USA)
44311

More information about COMMUNITY SUPPORT SERVICES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-01-01DOUG WAGNER2024-10-03
5022022-01-01DOUG WAGNER2023-06-26
5022021-01-01DOUG WAGNER2022-07-13
5022020-01-01DOUG WAGNER2021-10-14
5022019-01-01
5022019-01-01
5022018-01-01DOUGLAS WAGNER DOUGLAS WAGNER2019-07-23
5022017-01-01DOUGLAS WAGNER DOUGLAS WAGNER2018-10-12
5022016-01-01DOUGLAS WAGNER DOUGLAS WAGNER2017-07-24
5022015-01-01DOUGLAS WAGNER DOUGLAS WAGNER2016-07-12
5022014-01-01DOUGLAS WAGNER DOUGLAS WAGNER2015-10-15
5022013-01-01DOUGLAS WAGNER DOUGLAS WAGNER2014-10-31
5022012-01-01DOUGLAS WAGNER
5022011-01-01DOUGLAS WAGNER
5022009-01-01DOUGLAS WAGNER

Plan Statistics for COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN

401k plan membership statisitcs for COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN

Measure Date Value
2023: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01218
Total number of active participants reported on line 7a of the Form 55002023-01-01216
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01216
Number of employers contributing to the scheme2023-01-010
2022: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01216
Total number of active participants reported on line 7a of the Form 55002022-01-01218
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01218
Number of employers contributing to the scheme2022-01-010
2021: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01227
Total number of active participants reported on line 7a of the Form 55002021-01-01216
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01216
Number of employers contributing to the scheme2021-01-010
2020: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01232
Total number of active participants reported on line 7a of the Form 55002020-01-01227
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01227
Number of employers contributing to the scheme2020-01-010
2019: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01225
Total number of active participants reported on line 7a of the Form 55002019-01-01232
Total of all active and inactive participants2019-01-01232
Total participants2019-01-01232
2018: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01226
Total number of active participants reported on line 7a of the Form 55002018-01-01229
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01229
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01229
2017: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01227
Total number of active participants reported on line 7a of the Form 55002017-01-01222
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-014
Total of all active and inactive participants2017-01-01227
Total participants2017-01-01227
2016: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01200
Total number of active participants reported on line 7a of the Form 55002016-01-01220
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01220
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01208
Total number of active participants reported on line 7a of the Form 55002015-01-01193
Number of retired or separated participants receiving benefits2015-01-017
Total of all active and inactive participants2015-01-01200
Total participants2015-01-01200
2014: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01201
Total number of active participants reported on line 7a of the Form 55002014-01-01208
Total of all active and inactive participants2014-01-01208
Total participants2014-01-01208
2013: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01209
Total number of active participants reported on line 7a of the Form 55002013-01-01201
Total of all active and inactive participants2013-01-01201
Total participants2013-01-01201
2012: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01219
Total number of active participants reported on line 7a of the Form 55002012-01-01206
Number of retired or separated participants receiving benefits2012-01-013
Total of all active and inactive participants2012-01-01209
Total participants2012-01-01209
2011: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01217
Total number of active participants reported on line 7a of the Form 55002011-01-01216
Number of retired or separated participants receiving benefits2011-01-013
Total of all active and inactive participants2011-01-01219
Total participants2011-01-01219
2009: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01235
Total number of active participants reported on line 7a of the Form 55002009-01-01213
Number of retired or separated participants receiving benefits2009-01-014
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01217
Total participants2009-01-01217

Form 5500 Responses for COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN

2023: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: COMMUNITY SUPPORT SERVICES ACCIDENTAL DEATH AND DISABILITY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberOH2201
Policy instance 1
Insurance contract or identification numberOH2201
Number of Individuals Covered216
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $3,342
Total amount of fees paid to insurance companyUSD $82
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $143,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberOH2201
Policy instance 1
Insurance contract or identification numberOH2201
Number of Individuals Covered218
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,856
Total amount of fees paid to insurance companyUSD $343
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $191,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,856
Amount paid for insurance broker fees343
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberOH2201
Policy instance 1
Insurance contract or identification numberOH2201
Number of Individuals Covered216
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,873
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $191,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,873
Amount paid for insurance broker fees0
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberOH2201
Policy instance 1
Insurance contract or identification numberOH2201
Number of Individuals Covered227
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,832
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $172,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,832
Amount paid for insurance broker fees0
Insurance broker organization code?3
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberOH2201
Policy instance 1
Insurance contract or identification numberOH2201
Number of Individuals Covered232
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,564
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 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 BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $8,564
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered226
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $9,004
Total amount of fees paid to insurance companyUSD $5,889
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 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 BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $203
Amount paid for insurance broker fees5889
Additional information about fees paid to insurance brokerNOT PROVIDED
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered222
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,637
Total amount of fees paid to insurance companyUSD $6,309
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 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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered200
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,145,473
Total amount of fees paid to insurance companyUSD $44,295
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 BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 $104,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,145,473
Amount paid for insurance broker fees44295
Additional information about fees paid to insurance brokerNOT PROVIDED
Insurance broker organization code?3
Insurance broker nameEXPRESSLINK GENERAL AGENCY, LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered208
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $11,307
Total amount of fees paid to insurance companyUSD $6,151
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 BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 $102,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $11,307
Amount paid for insurance broker fees6151
Additional information about fees paid to insurance brokerNOT PROVIDED
Insurance broker organization code?3
Insurance broker nameEXPRESSLINK GENERAL AGENCY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered205
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11,288
Total amount of fees paid to insurance companyUSD $1,647
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 BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISABILITY
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 $101,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,647
Amount paid for insurance broker fees1647
Additional information about fees paid to insurance brokerNOT SPECIFIED
Insurance broker nameEXPRESSLINK GENERAL AGENCY LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered209
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,943
Total amount of fees paid to insurance companyUSD $4,572
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $101
Amount paid for insurance broker fees4752
Insurance broker nameEXPRESSLINK GENERAL AGENCY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered219
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,355
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 number00452843
Policy instance 1
Insurance contract or identification number00452843
Number of Individuals Covered216
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $9,661
Total amount of fees paid to insurance companyUSD $152
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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