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INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 401k Plan overview

Plan NameINDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN
Plan identification number 501

INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

INDIAN SUMMER DBA CHEROKEE CARPET INDUSTRIES has sponsored the creation of one or more 401k plans.

Company Name:INDIAN SUMMER DBA CHEROKEE CARPET INDUSTRIES
Employer identification number (EIN):582140827
NAIC Classification:313000
NAIC Description: Textile Mills

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-01-01RANDY HATCH
5012017-01-01RANDY HATCH
5012016-01-01JAMES ORR
5012015-01-01JAMES ORR
5012014-01-01AMANDA MASHBURN
5012013-01-01AMANDA MASHBURN
5012012-01-01AMANDA MASHBURN
5012011-12-01AMANDA MASHBURN
5012010-12-01AMANDA MASHBURN
5012009-12-01AMANDA MASHBURN

Plan Statistics for INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN

401k plan membership statisitcs for INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN

Measure Date Value
2018: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01128
Total number of active participants reported on line 7a of the Form 55002018-01-01135
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 participants2018-01-01135
2017: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01137
Total number of active participants reported on line 7a of the Form 55002017-01-01142
Total of all active and inactive participants2017-01-01142
2016: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01170
Total number of active participants reported on line 7a of the Form 55002016-01-01137
Total of all active and inactive participants2016-01-01137
2015: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01241
Total number of active participants reported on line 7a of the Form 55002015-01-01167
Number of retired or separated participants receiving benefits2015-01-013
Total of all active and inactive participants2015-01-01170
2014: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01290
Total number of active participants reported on line 7a of the Form 55002014-01-01240
Number of retired or separated participants receiving benefits2014-01-011
Total of all active and inactive participants2014-01-01241
2013: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01271
Total number of active participants reported on line 7a of the Form 55002013-01-01290
Total of all active and inactive participants2013-01-01290
2012: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01281
Total number of active participants reported on line 7a of the Form 55002012-01-01271
Total of all active and inactive participants2012-01-01271
2011: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01281
Total number of active participants reported on line 7a of the Form 55002011-12-01281
Total of all active and inactive participants2011-12-01281
2010: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-12-01327
Total number of active participants reported on line 7a of the Form 55002010-12-01281
Total of all active and inactive participants2010-12-01281
2009: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01288
Total number of active participants reported on line 7a of the Form 55002009-12-01323
Total of all active and inactive participants2009-12-01323
Total participants2009-12-010

Form 5500 Responses for INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN

2018: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
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 funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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 planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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 planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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 planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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 planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
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 planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
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 planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan funding arrangement – General assets of the sponsorYes
2011-12-01Plan benefit arrangement – InsuranceYes
2011-12-01Plan benefit arrangement – General assets of the sponsorYes
2010: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-12-01Type of plan entitySingle employer plan
2010-12-01Submission has been amendedNo
2010-12-01This submission is the final filingNo
2010-12-01This return/report is a short plan year return/report (less than 12 months)No
2010-12-01Plan is a collectively bargained planNo
2010-12-01Plan funding arrangement – InsuranceYes
2010-12-01Plan funding arrangement – General assets of the sponsorYes
2010-12-01Plan benefit arrangement – InsuranceYes
2010-12-01Plan benefit arrangement – General assets of the sponsorYes
2009: INDIAN SUMMER CARPET MILLS INC. DBA CHEROKEE CARPET INDUSTRIES WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan funding arrangement – General assets of the sponsorYes
2009-12-01Plan benefit arrangement – InsuranceYes
2009-12-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4712543
Policy instance 3
Insurance contract or identification numberE4712543
Number of Individuals Covered37
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,793
Total amount of fees paid to insurance companyUSD $511
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
Other welfare benefits providedACCIDENT, 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 CarrierUSD $17,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,203
Amount paid for insurance broker fees123
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4717807
Policy instance 2
Insurance contract or identification numberE4717807
Number of Individuals Covered18
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,779
Total amount of fees paid to insurance companyUSD $361
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
Other welfare benefits providedCRITICAL ILLNESS & ACCIDENT
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 $8,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $757
Amount paid for insurance broker fees85
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 1
Insurance contract or identification number00367778
Number of Individuals Covered165
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $17,268
Total amount of fees paid to insurance companyUSD $6,581
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D & VOLUNTARY LIFE, 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 CarrierUSD $177,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,268
Amount paid for insurance broker fees6581
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number4717807 4712543
Policy instance 2
Insurance contract or identification number4717807 4712543
Number of Individuals Covered62
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $14,983
Total amount of fees paid to insurance companyUSD $6,831
Other welfare benefits providedCRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $24,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46
Amount paid for insurance broker fees15
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameCAROL BARNES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberEL102-FL000103
Policy instance 3
Insurance contract or identification numberEL102-FL000103
Number of Individuals Covered99
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,008
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $216,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,008
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 1
Insurance contract or identification number00367778
Number of Individuals Covered142
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $15,596
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & VOLUNTARY LIFE, CIRTICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $149,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,596
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-200880
Policy instance 2
Insurance contract or identification numberUNI-200880
Number of Individuals Covered145
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $15,357
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $247,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,357
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTONY ASSEFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 1
Insurance contract or identification number00367778
Number of Individuals Covered167
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $18,262
Total amount of fees paid to insurance companyUSD $8,709
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & VOLUNTARY LIFE, CIRTICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $178,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,262
Amount paid for insurance broker fees8709
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 2
Insurance contract or identification number00367778
Number of Individuals Covered240
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $22,633
Total amount of fees paid to insurance companyUSD $8,911
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & VOLUNTARY LIFE, CIRTICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $236,402
Commission paid to Insurance BrokerUSD $22,633
Amount paid for insurance broker fees8911
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-200880
Policy instance 1
Insurance contract or identification numberUNI-200880
Number of Individuals Covered178
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $20,697
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $340,018
Commission paid to Insurance BrokerUSD $14,697
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTONY ASSEFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 2
Insurance contract or identification number00367778
Number of Individuals Covered290
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $24,004
Total amount of fees paid to insurance companyUSD $8,897
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & VOLUNTARY LIFE, CIRTICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $244,585
Commission paid to Insurance BrokerUSD $24,004
Amount paid for insurance broker fees8897
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-200880
Policy instance 1
Insurance contract or identification numberUNI-200880
Number of Individuals Covered190
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $20,697
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $362,735
Commission paid to Insurance BrokerUSD $14,697
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTONY ASSEFF
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-200880
Policy instance 1
Insurance contract or identification numberUNI-200880
Number of Individuals Covered231
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $21,305
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $353,732
Commission paid to Insurance BrokerUSD $15,305
Insurance broker organization code?3
Insurance broker nameTONY ASSEFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 2
Insurance contract or identification number00367778
Number of Individuals Covered271
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $24,416
Total amount of fees paid to insurance companyUSD $9,229
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $244,134
Commission paid to Insurance BrokerUSD $24,416
Amount paid for insurance broker fees9229
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-200880
Policy instance 2
Insurance contract or identification numberUNI-200880
Number of Individuals Covered208
Insurance policy start date2011-12-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,270
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,227
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 1
Insurance contract or identification number00367778
Number of Individuals Covered281
Insurance policy start date2011-12-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $0
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00367778
Policy instance 1
Insurance contract or identification number00367778
Number of Individuals Covered281
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $28,039
Total amount of fees paid to insurance companyUSD $8,911
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $280,745
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-200880
Policy instance 2
Insurance contract or identification numberUNI-200880
Number of Individuals Covered208
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $16,962
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $299,827

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