D.P. PREISS COMPANY, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN
401k plan membership statisitcs for D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN
Measure | Date | Value |
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2022: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-07-01 | 350 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 391 |
Number of retired or separated participants receiving benefits | 2022-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
Total of all active and inactive participants | 2022-07-01 | 391 |
2021: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-07-01 | 351 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 351 |
Number of retired or separated participants receiving benefits | 2021-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
Total of all active and inactive participants | 2021-07-01 | 352 |
2020: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-07-01 | 373 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 353 |
Number of retired or separated participants receiving benefits | 2020-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
Total of all active and inactive participants | 2020-07-01 | 354 |
2019: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-07-01 | 405 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 373 |
Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
Total of all active and inactive participants | 2019-07-01 | 373 |
2022: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2022 form 5500 responses |
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2022-07-01 | Type of plan entity | Single employer plan |
2022-07-01 | Submission has been amended | No |
2022-07-01 | This submission is the final filing | No |
2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-07-01 | Plan is a collectively bargained plan | No |
2022-07-01 | Plan funding arrangement – Insurance | Yes |
2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-07-01 | Plan benefit arrangement – Insurance | Yes |
2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2021 form 5500 responses |
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2021-07-01 | Type of plan entity | Single employer plan |
2021-07-01 | Submission has been amended | No |
2021-07-01 | This submission is the final filing | No |
2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-07-01 | Plan is a collectively bargained plan | No |
2021-07-01 | Plan funding arrangement – Insurance | Yes |
2021-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-07-01 | Plan benefit arrangement – Insurance | Yes |
2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2020 form 5500 responses |
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2020-07-01 | Type of plan entity | Single employer plan |
2020-07-01 | Submission has been amended | No |
2020-07-01 | This submission is the final filing | No |
2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-07-01 | Plan is a collectively bargained plan | No |
2020-07-01 | Plan funding arrangement – Insurance | Yes |
2020-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-07-01 | Plan benefit arrangement – Insurance | Yes |
2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: D.P. PREISS COMPANY, INC. HEALTH & WELFARE BENEFITS PLAN 2019 form 5500 responses |
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2019-07-01 | Type of plan entity | Single employer plan |
2019-07-01 | First time form 5500 has been submitted | Yes |
2019-07-01 | Submission has been amended | No |
2019-07-01 | This submission is the final filing | No |
2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-07-01 | Plan is a collectively bargained plan | No |
2019-07-01 | Plan funding arrangement – Insurance | Yes |
2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-07-01 | Plan benefit arrangement – Insurance | Yes |
2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 888091G |
Policy instance | 4 |
Insurance contract or identification number | 888091G | Number of Individuals Covered | 383 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $35,950 | Total amount of fees paid to insurance company | USD $21,865 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $183,708 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,949 | Amount paid for insurance broker fees | 7920 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 034947 |
Policy instance | 3 |
Insurance contract or identification number | 034947 | Number of Individuals Covered | 256 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $1,610 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $24,464 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,610 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00501432 |
Policy instance | 2 |
Insurance contract or identification number | 00501432 | Number of Individuals Covered | 287 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $12,080 | Total amount of fees paid to insurance company | USD $503 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $28,787 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,080 | Amount paid for insurance broker fees | 503 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
Policy contract number | 14170334-1001 |
Policy instance | 1 |
Insurance contract or identification number | 14170334-1001 | Number of Individuals Covered | 391 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $61,800 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,139,608 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,800 | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 888091G |
Policy instance | 4 |
Insurance contract or identification number | 888091G | Number of Individuals Covered | 105 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $10,000 | Total amount of fees paid to insurance company | USD $485 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $28,208 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,154 | Amount paid for insurance broker fees | 485 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 34947 |
Policy instance | 3 |
Insurance contract or identification number | 34947 | Number of Individuals Covered | 235 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $2,774 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $27,748 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,194 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00501432 |
Policy instance | 2 |
Insurance contract or identification number | 00501432 | Number of Individuals Covered | 364 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $35,100 | Total amount of fees paid to insurance company | USD $6,618 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $164,675 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,498 | Amount paid for insurance broker fees | 6618 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
Policy contract number | 14170334-1001 |
Policy instance | 1 |
Insurance contract or identification number | 14170334-1001 | Number of Individuals Covered | 373 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $39,050 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,983,473 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $39,050 | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 888091G |
Policy instance | 5 |
Insurance contract or identification number | 888091G | Number of Individuals Covered | 103 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $11,546 | Total amount of fees paid to insurance company | USD $119 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $30,351 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,546 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 119 | Additional information about fees paid to insurance broker | BONUS |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000B6R3 |
Policy instance | 4 |
Insurance contract or identification number | G000B6R3 | Number of Individuals Covered | 348 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $21,620 | Total amount of fees paid to insurance company | USD $7,807 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $137,236 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,620 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 7807 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 34947 |
Policy instance | 3 |
Insurance contract or identification number | 34947 | Number of Individuals Covered | 219 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $2,244 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $22,444 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,244 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00501432 |
Policy instance | 2 |
Insurance contract or identification number | 00501432 | Number of Individuals Covered | 265 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $11,408 | Total amount of fees paid to insurance company | USD $2,008 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $28,591 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,408 | Amount paid for insurance broker fees | 2008 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3339878 |
Policy instance | 1 |
Insurance contract or identification number | 3339878 | Number of Individuals Covered | 365 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $80,705 | Total amount of fees paid to insurance company | USD $4,416 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $509,097 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $80,705 | Amount paid for insurance broker fees | 4416 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 888091G |
Policy instance | 5 |
Insurance contract or identification number | 888091G | Number of Individuals Covered | 96 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $16,230 | Total amount of fees paid to insurance company | USD $1,127 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $23,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,230 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1127 | Additional information about fees paid to insurance broker | BONUS |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000B6R3 |
Policy instance | 4 |
Insurance contract or identification number | G000B6R3 | Number of Individuals Covered | 374 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $20,882 | Total amount of fees paid to insurance company | USD $8,498 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $134,082 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,882 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 8498 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 34947 |
Policy instance | 3 |
Insurance contract or identification number | 34947 | Number of Individuals Covered | 238 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $2,458 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $24,576 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,458 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00501432 |
Policy instance | 2 |
Insurance contract or identification number | 00501432 | Number of Individuals Covered | 281 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $11,305 | Total amount of fees paid to insurance company | USD $2,371 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $28,333 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,305 | Amount paid for insurance broker fees | 2371 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3339878 |
Policy instance | 1 |
Insurance contract or identification number | 3339878 | Number of Individuals Covered | 361 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $80,700 | Total amount of fees paid to insurance company | USD $4,539 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $439,880 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $80,700 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 4539 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES |
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