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GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 401k Plan overview

Plan NameGROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC
Plan identification number 501

GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

HARRINGTON INDUSTRIAL PLASTICS, LLC has sponsored the creation of one or more 401k plans.

Company Name:HARRINGTON INDUSTRIAL PLASTICS, LLC
Employer identification number (EIN):952752402
NAIC Classification:326100

Additional information about HARRINGTON INDUSTRIAL PLASTICS, LLC

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: 200302410063

More information about HARRINGTON INDUSTRIAL PLASTICS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01HEATHER WARREN2023-05-10
5012021-01-01HEATHER WARREN2022-09-05
5012020-01-01HEATHER WARREN2021-09-20
5012019-10-01HEATHER WARREN2020-08-24
5012018-10-01HEATHER WARREN2020-07-15
5012017-10-01HEATHER WARREN2019-04-18
5012016-10-01
5012015-10-01HEATHER WARREN
5012014-10-01HEATHER WARREN
5012013-10-01JOHN ROONEY
5012012-10-01JOHN ROONEY
5012011-10-01HEATHER WARREN
5012010-10-01JOHN ROONEY
5012009-10-01JOHN ROONEY

Plan Statistics for GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC

401k plan membership statisitcs for GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC

Measure Date Value
2022: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2022 401k membership
Total participants, beginning-of-year2022-01-01538
Total number of active participants reported on line 7a of the Form 55002022-01-01429
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01429
Number of employers contributing to the scheme2022-01-010
2021: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2021 401k membership
Total participants, beginning-of-year2021-01-01574
Total number of active participants reported on line 7a of the Form 55002021-01-01563
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01563
Number of employers contributing to the scheme2021-01-010
2020: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2020 401k membership
Total participants, beginning-of-year2020-01-01447
Total number of active participants reported on line 7a of the Form 55002020-01-01574
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01574
Number of employers contributing to the scheme2020-01-010
2019: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2019 401k membership
Total participants, beginning-of-year2019-10-01392
Total number of active participants reported on line 7a of the Form 55002019-10-01532
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01532
Number of employers contributing to the scheme2019-10-010
2018: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2018 401k membership
Total participants, beginning-of-year2018-10-01445
Total number of active participants reported on line 7a of the Form 55002018-10-01447
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01447
Number of employers contributing to the scheme2018-10-010
2017: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2017 401k membership
Total participants, beginning-of-year2017-10-01426
Total number of active participants reported on line 7a of the Form 55002017-10-01437
Number of retired or separated participants receiving benefits2017-10-018
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01445
Number of employers contributing to the scheme2017-10-010
2016: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2016 401k membership
Total participants, beginning-of-year2016-10-01478
Total number of active participants reported on line 7a of the Form 55002016-10-01445
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01445
2015: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2015 401k membership
Total participants, beginning-of-year2015-10-01474
Total number of active participants reported on line 7a of the Form 55002015-10-01440
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01440
2014: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2014 401k membership
Total participants, beginning-of-year2014-10-01389
Total number of active participants reported on line 7a of the Form 55002014-10-01474
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01474
2013: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2013 401k membership
Total participants, beginning-of-year2013-10-01420
Total number of active participants reported on line 7a of the Form 55002013-10-01389
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01389
2012: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2012 401k membership
Total participants, beginning-of-year2012-10-01416
Total number of active participants reported on line 7a of the Form 55002012-10-01418
Number of retired or separated participants receiving benefits2012-10-012
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01420
2011: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2011 401k membership
Total participants, beginning-of-year2011-10-01347
Total number of active participants reported on line 7a of the Form 55002011-10-01377
Number of retired or separated participants receiving benefits2011-10-013
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01380
2010: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2010 401k membership
Total participants, beginning-of-year2010-10-01388
Total number of active participants reported on line 7a of the Form 55002010-10-01392
Number of retired or separated participants receiving benefits2010-10-015
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-01397
Total participants2010-10-01397
2009: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2009 401k membership
Total participants, beginning-of-year2009-10-01403
Total number of active participants reported on line 7a of the Form 55002009-10-01379
Number of retired or separated participants receiving benefits2009-10-019
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01388

Form 5500 Responses for GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC

2022: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2013: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes
2011: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – InsuranceYes
2010: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – InsuranceYes
2009: GROUP LIFE AND HEALTH INS. PLAN FOR EES OF HARRINGTON INDUSTRIAL PLASTICS, LLC 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HEALTHJOY, LLC (National Association of Insurance Commissioners NAIC id number: 51121 )
Policy contract numberHIPCO
Policy instance 3
Insurance contract or identification numberHIPCO
Number of Individuals Covered532
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTELEHEALTH
Welfare Benefit Premiums Paid to CarrierUSD $42,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96959
Policy instance 2
Insurance contract or identification number96959
Number of Individuals Covered98
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,746
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $31,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,746
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberL04239
Policy instance 1
Insurance contract or identification numberL04239
Number of Individuals Covered1111
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $7,124,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number38081
Policy instance 1
Insurance contract or identification number38081
Number of Individuals Covered462
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number556021
Policy instance 2
Insurance contract or identification number556021
Number of Individuals Covered498
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $460,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96959
Policy instance 3
Insurance contract or identification number96959
Number of Individuals Covered61
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,832
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $18,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,832
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305961
Policy instance 4
Insurance contract or identification number305961
Number of Individuals Covered727
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $6,934,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number26201
Policy instance 5
Insurance contract or identification number26201
Number of Individuals Covered115
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $15,623
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $46,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,487
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number556021
Policy instance 4
Insurance contract or identification number556021
Number of Individuals Covered493
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number38081
Policy instance 3
Insurance contract or identification number38081
Number of Individuals Covered445
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number916360
Policy instance 2
Insurance contract or identification number916360
Number of Individuals Covered574
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,066,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305961
Policy instance 1
Insurance contract or identification number305961
Number of Individuals Covered728
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $246,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number556021
Policy instance 2
Insurance contract or identification number556021
Number of Individuals Covered451
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $422,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberCGS80
Policy instance 3
Insurance contract or identification numberCGS80
Number of Individuals Covered124
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $20,284
Total amount of fees paid to insurance companyUSD $1,176
Other welfare benefits providedACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $130,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,462
Amount paid for insurance broker fees560
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberCGS80
Policy instance 4
Insurance contract or identification numberCGS80
Number of Individuals Covered123
Insurance policy start date2019-10-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,071
Total amount of fees paid to insurance companyUSD $508
Other welfare benefits providedACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $31,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,527
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number916360
Policy instance 5
Insurance contract or identification number916360
Number of Individuals Covered1034
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $6,532,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number38081
Policy instance 1
Insurance contract or identification number38081
Number of Individuals Covered392
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number916360
Policy instance 1
Insurance contract or identification number916360
Number of Individuals Covered1034
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,294,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3341197
Policy instance 2
Insurance contract or identification number3341197
Number of Individuals Covered1005
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $10,000
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,492,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees10000
Additional information about fees paid to insurance brokerSERVICE/GENERAL AGENT FEES
Insurance broker organization code?3
CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3341197
Policy instance 3
Insurance contract or identification number3341197
Number of Individuals Covered123
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969498
Policy instance 4
Insurance contract or identification numberOK969498
Number of Individuals Covered447
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $100,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3341197
Policy instance 1
Insurance contract or identification number3341197
Number of Individuals Covered1032
Insurance policy start date2017-10-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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