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BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 401k Plan overview

Plan NameBUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT
Plan identification number 507

BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

UNIVERSITY OF BRIDGEPORT has sponsored the creation of one or more 401k plans.

Company Name:UNIVERSITY OF BRIDGEPORT
Employer identification number (EIN):060646936
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072020-09-25CHERYL M. NYARADY2022-04-06
5072019-09-25
5072018-09-25
5072017-09-25MELITHA PRZYGODA
5072016-09-25MELITHA PRZYGODA MELITHA PRZYGODA2018-01-30
5072015-09-25MELITHA PRZYGODA
5072014-09-25MELITHA PRZYGODA
5072013-09-25MELITHA PRZYGODA
5072012-09-25MELITHA PRZYGODA
5072011-09-25MELITHA PRZYGODA
5072009-09-25MELITHA PRZYGODA

Plan Statistics for BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT

401k plan membership statisitcs for BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT

Measure Date Value
2020: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2020 401k membership
Total participants, beginning-of-year2020-09-25300
Total number of active participants reported on line 7a of the Form 55002020-09-250
Number of retired or separated participants receiving benefits2020-09-250
Number of other retired or separated participants entitled to future benefits2020-09-250
Total of all active and inactive participants2020-09-250
Number of employers contributing to the scheme2020-09-250
2019: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2019 401k membership
Total participants, beginning-of-year2019-09-25300
Total number of active participants reported on line 7a of the Form 55002019-09-25300
Total of all active and inactive participants2019-09-25300
Total participants2019-09-25300
2018: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2018 401k membership
Total participants, beginning-of-year2018-09-25300
Total number of active participants reported on line 7a of the Form 55002018-09-25300
Number of retired or separated participants receiving benefits2018-09-250
Number of other retired or separated participants entitled to future benefits2018-09-250
Total of all active and inactive participants2018-09-25300
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-09-250
Total participants2018-09-25300
Number of participants with account balances2018-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-09-250
Number of employers contributing to the scheme2018-09-250
2017: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2017 401k membership
Total participants, beginning-of-year2017-09-25300
Total number of active participants reported on line 7a of the Form 55002017-09-25300
Number of retired or separated participants receiving benefits2017-09-250
Number of other retired or separated participants entitled to future benefits2017-09-250
Total of all active and inactive participants2017-09-25300
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-09-250
Total participants2017-09-25300
Number of participants with account balances2017-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-09-250
Number of employers contributing to the scheme2017-09-250
2016: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2016 401k membership
Total participants, beginning-of-year2016-09-25300
Total number of active participants reported on line 7a of the Form 55002016-09-25300
Number of retired or separated participants receiving benefits2016-09-250
Number of other retired or separated participants entitled to future benefits2016-09-250
Total of all active and inactive participants2016-09-25300
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-09-250
Total participants2016-09-25300
Number of participants with account balances2016-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-09-250
Number of employers contributing to the scheme2016-09-250
2015: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2015 401k membership
Total participants, beginning-of-year2015-09-25285
Total number of active participants reported on line 7a of the Form 55002015-09-25285
Number of retired or separated participants receiving benefits2015-09-250
Number of other retired or separated participants entitled to future benefits2015-09-250
Total of all active and inactive participants2015-09-25285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-09-250
Total participants2015-09-25285
Number of participants with account balances2015-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-09-250
Number of employers contributing to the scheme2015-09-250
2014: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2014 401k membership
Total participants, beginning-of-year2014-09-25285
Total number of active participants reported on line 7a of the Form 55002014-09-25285
Total of all active and inactive participants2014-09-25285
Total participants2014-09-25285
Number of employers contributing to the scheme2014-09-250
2013: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2013 401k membership
Total participants, beginning-of-year2013-09-25285
Total number of active participants reported on line 7a of the Form 55002013-09-25285
Number of retired or separated participants receiving benefits2013-09-250
Number of other retired or separated participants entitled to future benefits2013-09-250
Total of all active and inactive participants2013-09-25285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-09-250
Total participants2013-09-25285
Number of participants with account balances2013-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-09-250
Number of employers contributing to the scheme2013-09-250
2012: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2012 401k membership
Total participants, beginning-of-year2012-09-25285
Total number of active participants reported on line 7a of the Form 55002012-09-25285
Number of retired or separated participants receiving benefits2012-09-250
Number of other retired or separated participants entitled to future benefits2012-09-250
Total of all active and inactive participants2012-09-25285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-09-250
Total participants2012-09-25285
Number of participants with account balances2012-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-09-250
Number of employers contributing to the scheme2012-09-250
2011: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2011 401k membership
Total participants, beginning-of-year2011-09-25285
Total number of active participants reported on line 7a of the Form 55002011-09-25285
Number of retired or separated participants receiving benefits2011-09-250
Number of other retired or separated participants entitled to future benefits2011-09-250
Total of all active and inactive participants2011-09-25285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-09-250
Total participants2011-09-25285
Number of participants with account balances2011-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-09-250
Number of employers contributing to the scheme2011-09-250
2009: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2009 401k membership
Total participants, beginning-of-year2009-09-25225
Total number of active participants reported on line 7a of the Form 55002009-09-25285
Number of retired or separated participants receiving benefits2009-09-250
Number of other retired or separated participants entitled to future benefits2009-09-250
Total of all active and inactive participants2009-09-25285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-09-250
Total participants2009-09-25285
Number of participants with account balances2009-09-250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-09-250
Number of employers contributing to the scheme2009-09-250

Form 5500 Responses for BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT

2020: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2020 form 5500 responses
2020-09-25Type of plan entitySingle employer plan
2020-09-25This submission is the final filingYes
2020-09-25This return/report is a short plan year return/report (less than 12 months)Yes
2020-09-25Plan funding arrangement – InsuranceYes
2020-09-25Plan benefit arrangement – InsuranceYes
2019: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2019 form 5500 responses
2019-09-25Type of plan entitySingle employer plan
2019-09-25Submission has been amendedNo
2019-09-25This submission is the final filingNo
2019-09-25This return/report is a short plan year return/report (less than 12 months)No
2019-09-25Plan is a collectively bargained planNo
2019-09-25Plan funding arrangement – InsuranceYes
2019-09-25Plan benefit arrangement – InsuranceYes
2018: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2018 form 5500 responses
2018-09-25Type of plan entitySingle employer plan
2018-09-25Submission has been amendedNo
2018-09-25This submission is the final filingNo
2018-09-25This return/report is a short plan year return/report (less than 12 months)No
2018-09-25Plan is a collectively bargained planYes
2018-09-25Plan funding arrangement – InsuranceYes
2018-09-25Plan benefit arrangement – InsuranceYes
2017: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2017 form 5500 responses
2017-09-25Type of plan entitySingle employer plan
2017-09-25Submission has been amendedNo
2017-09-25This submission is the final filingNo
2017-09-25This return/report is a short plan year return/report (less than 12 months)No
2017-09-25Plan is a collectively bargained planYes
2017-09-25Plan funding arrangement – InsuranceYes
2017-09-25Plan benefit arrangement – InsuranceYes
2016: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2016 form 5500 responses
2016-09-25Type of plan entitySingle employer plan
2016-09-25Submission has been amendedNo
2016-09-25This submission is the final filingNo
2016-09-25This return/report is a short plan year return/report (less than 12 months)No
2016-09-25Plan is a collectively bargained planYes
2016-09-25Plan funding arrangement – InsuranceYes
2016-09-25Plan benefit arrangement – InsuranceYes
2015: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2015 form 5500 responses
2015-09-25Type of plan entitySingle employer plan
2015-09-25Submission has been amendedNo
2015-09-25This submission is the final filingNo
2015-09-25This return/report is a short plan year return/report (less than 12 months)No
2015-09-25Plan is a collectively bargained planYes
2015-09-25Plan funding arrangement – InsuranceYes
2015-09-25Plan benefit arrangement – InsuranceYes
2014: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2014 form 5500 responses
2014-09-25Type of plan entitySingle employer plan
2014-09-25Submission has been amendedNo
2014-09-25This submission is the final filingNo
2014-09-25This return/report is a short plan year return/report (less than 12 months)No
2014-09-25Plan is a collectively bargained planYes
2014-09-25Plan funding arrangement – InsuranceYes
2014-09-25Plan benefit arrangement – InsuranceYes
2013: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2013 form 5500 responses
2013-09-25Type of plan entitySingle employer plan
2013-09-25Submission has been amendedNo
2013-09-25This submission is the final filingNo
2013-09-25This return/report is a short plan year return/report (less than 12 months)No
2013-09-25Plan is a collectively bargained planYes
2013-09-25Plan funding arrangement – InsuranceYes
2013-09-25Plan benefit arrangement – InsuranceYes
2012: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2012 form 5500 responses
2012-09-25Type of plan entitySingle employer plan
2012-09-25Submission has been amendedNo
2012-09-25This submission is the final filingNo
2012-09-25This return/report is a short plan year return/report (less than 12 months)No
2012-09-25Plan is a collectively bargained planYes
2012-09-25Plan funding arrangement – InsuranceYes
2012-09-25Plan benefit arrangement – InsuranceYes
2011: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2011 form 5500 responses
2011-09-25Type of plan entitySingle employer plan
2011-09-25Submission has been amendedNo
2011-09-25This submission is the final filingNo
2011-09-25This return/report is a short plan year return/report (less than 12 months)No
2011-09-25Plan is a collectively bargained planYes
2011-09-25Plan funding arrangement – InsuranceYes
2011-09-25Plan benefit arrangement – InsuranceYes
2009: BUSINESS TRAVEL ACCIDENT INSURANCE FOR THE UNIVERSITY OF BRIDGEPORT 2009 form 5500 responses
2009-09-25Type of plan entitySingle employer plan
2009-09-25Submission has been amendedNo
2009-09-25This submission is the final filingNo
2009-09-25This return/report is a short plan year return/report (less than 12 months)No
2009-09-25Plan is a collectively bargained planYes
2009-09-25Plan funding arrangement – InsuranceYes
2009-09-25Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Insurance policy start date2020-09-25
Insurance policy end date2020-09-25
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered300
Insurance policy start date2019-09-25
Insurance policy end date2020-09-24
Total amount of commissions paid to insurance brokerUSD $339
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $339
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered300
Insurance policy start date2018-09-24
Insurance policy end date2019-09-24
Total amount of commissions paid to insurance brokerUSD $339
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $331
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered300
Insurance policy start date2017-09-25
Insurance policy end date2018-09-24
Total amount of commissions paid to insurance brokerUSD $339
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
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 numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered285
Insurance policy start date2015-09-25
Insurance policy end date2016-09-24
Total amount of commissions paid to insurance brokerUSD $331
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $331
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker namePEOPLES UNITED INSURANCE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered285
Insurance policy start date2014-09-25
Insurance policy end date2015-09-24
Total amount of commissions paid to insurance brokerUSD $331
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $331
Amount paid for insurance broker fees33
Additional information about fees paid to insurance brokerOVERIDE
Insurance broker organization code?3
Insurance broker namePEOPLES UNITED INSURANCE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered285
Insurance policy start date2013-09-25
Insurance policy end date2014-09-24
Total amount of commissions paid to insurance brokerUSD $331
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $331
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker namePEOPLES UNITED INSURANCE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered285
Insurance policy start date2012-09-25
Insurance policy end date2013-09-24
Total amount of commissions paid to insurance brokerUSD $331
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $331
Amount paid for insurance broker fees39
Insurance broker organization code?3
Insurance broker namePEOPLES UNITED INSURANCE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered285
Insurance policy start date2011-09-25
Insurance policy end date2012-09-24
Total amount of commissions paid to insurance brokerUSD $331
Total amount of fees paid to insurance companyUSD $0
Life 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 numberABL961279
Policy instance 1
Insurance contract or identification numberABL961279
Number of Individuals Covered285
Insurance policy start date2010-09-25
Insurance policy end date2011-09-24
Total amount of commissions paid to insurance brokerUSD $389
Total amount of fees paid to insurance companyUSD $39
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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