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ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 401k Plan overview

Plan NameERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY
Plan identification number 505

ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Long-term disability cover

401k Sponsoring company profile

ERIE HOMES FOR CHILDREN AND ADULTS, INC has sponsored the creation of one or more 401k plans.

Company Name:ERIE HOMES FOR CHILDREN AND ADULTS, INC
Employer identification number (EIN):250967472
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-02-01
5052021-02-01
5052020-02-01
5052019-02-01
5052018-02-01SHANNON WEBER SHANNON WEBER2019-07-10
5052017-07-01SHANNON WEBER SHANNON WEBER2018-08-09
5052017-02-01SHANNON WEBER SHANNON WEBER2018-08-09
5052016-02-01SHANNON WEBER SHANNON WEBER2017-08-22
5052015-02-01SHANNON WEBER SHANNON WEBER2016-06-16
5052014-11-01SHANNON WEBER SHANNON WEBER2015-07-30
5052013-11-01SHANNON WEBER2014-12-15 SHANNON WEBER2014-12-15
5052012-11-01SHANNON WEBER2014-12-11 SHANNON WEBER2014-12-11
5052011-11-01SHANNON WEBER2014-12-11 SHANNON WEBER2014-12-11
5052010-11-01SHANNON WEBER2014-12-11 SHANNON WEBER2014-12-11
5052009-11-01SHANNON WEBER2014-12-11 SHANNON WEBER2014-12-11
5052008-11-01SHANNON WEBER2014-12-11 SHANNON WEBER2014-12-11
5052007-11-01SHANNON WEBER2014-12-11 SHANNON WEBER2014-12-11
5052006-11-01SHANNON WEBER2014-12-11 SHANNON WEBER2014-12-11

Plan Statistics for ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY

401k plan membership statisitcs for ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY

Measure Date Value
2022: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2022 401k membership
Total participants, beginning-of-year2022-02-01240
Total number of active participants reported on line 7a of the Form 55002022-02-01218
Total of all active and inactive participants2022-02-01218
Total participants2022-02-01218
2021: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2021 401k membership
Total participants, beginning-of-year2021-02-01253
Total number of active participants reported on line 7a of the Form 55002021-02-01240
Total of all active and inactive participants2021-02-01240
Total participants2021-02-01240
2020: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2020 401k membership
Total participants, beginning-of-year2020-02-01248
Total number of active participants reported on line 7a of the Form 55002020-02-01253
Total of all active and inactive participants2020-02-01253
Total participants2020-02-01253
2019: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2019 401k membership
Total participants, beginning-of-year2019-02-01242
Total number of active participants reported on line 7a of the Form 55002019-02-01248
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01248
Total participants2019-02-01248
2018: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2018 401k membership
Total participants, beginning-of-year2018-02-01248
Total number of active participants reported on line 7a of the Form 55002018-02-01242
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-02-010
Total participants2018-02-01242
Number of participants with account balances2018-02-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-02-010
2017: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year2017-07-01241
Total number of active participants reported on line 7a of the Form 55002017-07-01248
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01248
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
Total participants2017-07-01248
Number of participants with account balances2017-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-07-010
Number of employers contributing to the scheme2017-07-010
Total participants, beginning-of-year2017-02-01249
Total number of active participants reported on line 7a of the Form 55002017-02-01241
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-02-010
Total participants2017-02-01241
Number of participants with account balances2017-02-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-02-010
Number of employers contributing to the scheme2017-02-010
2016: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year2016-02-01249
Total number of active participants reported on line 7a of the Form 55002016-02-01249
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-02-010
Total participants2016-02-01249
Number of participants with account balances2016-02-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-02-010
Number of employers contributing to the scheme2016-02-010
2015: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year2015-02-01245
Total number of active participants reported on line 7a of the Form 55002015-02-01249
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-02-010
Total participants2015-02-01249
Number of participants with account balances2015-02-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-02-010
Number of employers contributing to the scheme2015-02-010
2014: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year2014-11-01244
Total number of active participants reported on line 7a of the Form 55002014-11-01245
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01245
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-11-010
Total participants2014-11-01245
Number of participants with account balances2014-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-11-010
2013: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year2013-11-01244
Total number of active participants reported on line 7a of the Form 55002013-11-01246
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-010
Total of all active and inactive participants2013-11-01246
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-11-010
Total participants2013-11-01246
Number of participants with account balances2013-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-11-010
Number of employers contributing to the scheme2013-11-010
2012: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year2012-11-01219
Total number of active participants reported on line 7a of the Form 55002012-11-01244
Number of retired or separated participants receiving benefits2012-11-010
Number of other retired or separated participants entitled to future benefits2012-11-010
Total of all active and inactive participants2012-11-01244
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-11-010
Total participants2012-11-01244
Number of participants with account balances2012-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-11-010
Number of employers contributing to the scheme2012-11-010
2011: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year2011-11-01204
Total number of active participants reported on line 7a of the Form 55002011-11-01219
Number of retired or separated participants receiving benefits2011-11-010
Number of other retired or separated participants entitled to future benefits2011-11-010
Total of all active and inactive participants2011-11-01219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-11-010
Total participants2011-11-01219
Number of participants with account balances2011-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-11-010
Number of employers contributing to the scheme2011-11-010
2010: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year2010-11-01199
Total number of active participants reported on line 7a of the Form 55002010-11-01204
Number of retired or separated participants receiving benefits2010-11-010
Number of other retired or separated participants entitled to future benefits2010-11-010
Total of all active and inactive participants2010-11-01204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-11-010
Total participants2010-11-01204
Number of participants with account balances2010-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-11-010
Number of employers contributing to the scheme2010-11-010
2009: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year2009-11-01184
Total number of active participants reported on line 7a of the Form 55002009-11-01199
Number of retired or separated participants receiving benefits2009-11-010
Number of other retired or separated participants entitled to future benefits2009-11-010
Total of all active and inactive participants2009-11-01199
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-11-010
Total participants2009-11-01199
Number of participants with account balances2009-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-11-010
Number of employers contributing to the scheme2009-11-010
2008: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2008 401k membership
Total participants, beginning-of-year2008-11-01183
Total number of active participants reported on line 7a of the Form 55002008-11-01184
Number of retired or separated participants receiving benefits2008-11-010
Number of other retired or separated participants entitled to future benefits2008-11-010
Total of all active and inactive participants2008-11-01184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-11-010
Total participants2008-11-01184
Number of participants with account balances2008-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-11-010
Number of employers contributing to the scheme2008-11-010
2007: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2007 401k membership
Total participants, beginning-of-year2007-11-01175
Total number of active participants reported on line 7a of the Form 55002007-11-01183
Number of retired or separated participants receiving benefits2007-11-010
Number of other retired or separated participants entitled to future benefits2007-11-010
Total of all active and inactive participants2007-11-01183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-11-010
Total participants2007-11-01183
Number of participants with account balances2007-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2007-11-010
Number of employers contributing to the scheme2007-11-010
2006: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2006 401k membership
Total participants, beginning-of-year2006-11-01171
Total number of active participants reported on line 7a of the Form 55002006-11-01175
Number of retired or separated participants receiving benefits2006-11-010
Number of other retired or separated participants entitled to future benefits2006-11-010
Total of all active and inactive participants2006-11-01175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2006-11-010
Total participants2006-11-01175
Number of participants with account balances2006-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2006-11-010
Number of employers contributing to the scheme2006-11-010

Form 5500 Responses for ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY

2022: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Submission has been amendedNo
2021-02-01This submission is the final filingNo
2021-02-01This return/report is a short plan year return/report (less than 12 months)No
2021-02-01Plan is a collectively bargained planNo
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2020: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Submission has been amendedNo
2020-02-01This submission is the final filingNo
2020-02-01This return/report is a short plan year return/report (less than 12 months)No
2020-02-01Plan is a collectively bargained planNo
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Submission has been amendedNo
2019-02-01This submission is the final filingNo
2019-02-01This return/report is a short plan year return/report (less than 12 months)No
2019-02-01Plan is a collectively bargained planNo
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Submission has been amendedNo
2018-02-01This submission is the final filingNo
2018-02-01This return/report is a short plan year return/report (less than 12 months)No
2018-02-01Plan is a collectively bargained planNo
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-02-01Type of plan entitySingle employer plan
2017-02-01Submission has been amendedNo
2017-02-01This submission is the final filingNo
2017-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-02-01Plan is a collectively bargained planNo
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – InsuranceYes
2013: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – InsuranceYes
2012: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – InsuranceYes
2011: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – InsuranceYes
2010: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan benefit arrangement – InsuranceYes
2009: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – InsuranceYes
2008: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2008 form 5500 responses
2008-11-01Type of plan entitySingle employer plan
2008-11-01Submission has been amendedNo
2008-11-01This submission is the final filingNo
2008-11-01This return/report is a short plan year return/report (less than 12 months)No
2008-11-01Plan is a collectively bargained planNo
2008-11-01Plan funding arrangement – InsuranceYes
2008-11-01Plan benefit arrangement – InsuranceYes
2007: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2007 form 5500 responses
2007-11-01Type of plan entitySingle employer plan
2007-11-01Submission has been amendedNo
2007-11-01This submission is the final filingNo
2007-11-01This return/report is a short plan year return/report (less than 12 months)No
2007-11-01Plan is a collectively bargained planNo
2007-11-01Plan funding arrangement – InsuranceYes
2007-11-01Plan benefit arrangement – InsuranceYes
2006: ERIE HOMES FOR CHILDREN AND ADULTS LONG TERM DISABILITY 2006 form 5500 responses
2006-11-01Type of plan entitySingle employer plan
2006-11-01Submission has been amendedNo
2006-11-01This submission is the final filingNo
2006-11-01This return/report is a short plan year return/report (less than 12 months)No
2006-11-01Plan is a collectively bargained planNo
2006-11-01Plan funding arrangement – InsuranceYes
2006-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 128905
Policy instance 1
Insurance contract or identification numberLTD 128905
Number of Individuals Covered218
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $4,395
Total amount of fees paid to insurance companyUSD $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?Yes
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 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 $40,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP INSURANCE
Commission paid to Insurance BrokerUSD $4,395
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 128905
Policy instance 1
Insurance contract or identification numberLTD 128905
Number of Individuals Covered240
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $3,652
Total amount of fees paid to insurance companyUSD $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?Yes
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 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 $31,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP INSURANCE
Commission paid to Insurance BrokerUSD $3,652
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD128905
Policy instance 1
Insurance contract or identification numberLTD128905
Number of Individuals Covered253
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $3,265
Total amount of fees paid to insurance companyUSD $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?Yes
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 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 $27,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP INSURANCE
Commission paid to Insurance BrokerUSD $3,265
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 128905
Policy instance 1
Insurance contract or identification numberLTD 128905
Number of Individuals Covered248
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $3,513
Total amount of fees paid to insurance companyUSD $331
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?Yes
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 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 $29,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP INSURANCE
Commission paid to Insurance BrokerUSD $3,513
Amount paid for insurance broker fees331
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 128905
Policy instance 1
Insurance contract or identification numberLTD 128905
Number of Individuals Covered242
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $3,421
Total amount of fees paid to insurance companyUSD $336
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?Yes
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 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 $27,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP INSURANCE
Commission paid to Insurance BrokerUSD $3,421
Amount paid for insurance broker fees336
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 128905
Policy instance 1
Insurance contract or identification numberLTD 128905
Number of Individuals Covered248
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $3,333
Total amount of fees paid to insurance companyUSD $336
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?Yes
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 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 $26,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP INSURANCE
Commission paid to Insurance BrokerUSD $3,333
Amount paid for insurance broker fees336
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
Insurance broker nameLOESELL-SCHAFF INSURANCE AGENCY
AETNA LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0478017
Policy instance 1
Insurance contract or identification number0478017
Number of Individuals Covered241
Insurance policy start date2017-02-01
Insurance policy end date2017-06-30
Total amount of commissions paid to insurance brokerUSD $2,064
Total amount of fees paid to insurance companyUSD $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?Yes
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 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 $13,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP INSURANCE
Commission paid to Insurance BrokerUSD $2,064
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
Insurance broker nameLOESELL-SCHAFF INSURANCE AGENCY

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