401k Plan data: SHORT TERM DISABILITY PLAN plan

SHORT TERM DISABILITY PLAN 401k Plan overview

Plan Name	SHORT TERM DISABILITY PLAN
Plan identification number	510

SHORT TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

DAVIS POLK & WARDWELL LLP has sponsored the creation of one or more 401k plans.

Company Name: DAVIS POLK & WARDWELL LLP

Employer identification number (EIN): 135023295

Additional information about DAVIS POLK & WARDWELL LLP

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2009-06-18

Company Identification Number: 3823719

Legal Registered Office Address: 450 LEXINGTON AVENUE

NEW YORK
United States of America (USA)
10017

More information about DAVIS POLK & WARDWELL LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHORT TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2015-01-01
510 2014-01-01 JEANNIE M. GRATTA
510 2013-01-01 JEANNIE M. GRATTA
510 2012-01-01 JEANNIE M. GRATTA
510 2011-01-01 JEANNIE M. GRATTA JEANNIE M. GRATTA 2012-10-12
510 2009-01-01 JEANNIE M. GRATTA JEANNIE M. GRATTA 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
510	2015-01-01
510	2014-01-01	JEANNIE M. GRATTA
510	2013-01-01	JEANNIE M. GRATTA
510	2012-01-01	JEANNIE M. GRATTA
510	2011-01-01	JEANNIE M. GRATTA	JEANNIE M. GRATTA	2012-10-12
510	2009-01-01	JEANNIE M. GRATTA	JEANNIE M. GRATTA	2010-10-14

Plan Statistics for SHORT TERM DISABILITY PLAN

401k plan membership statisitcs for SHORT TERM DISABILITY PLAN

Measure Date Value
2015: SHORT TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,389
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
2014: SHORT TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,349
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,389
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 1,389
2013: SHORT TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,379
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,349
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 1,349
2012: SHORT TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,610
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,379
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1,379
2011: SHORT TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,382
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,392
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 1,392
2009: SHORT TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,517
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,428
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 1,428

Measure	Date	Value
2015: SHORT TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,389
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
2014: SHORT TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,349
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,389
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	1,389
2013: SHORT TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,379
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,349
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	1,349
2012: SHORT TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,610
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,379
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1,379
2011: SHORT TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,382
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,392
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	1,392
2009: SHORT TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,517
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,428
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	1,428

Form 5500 Responses for SHORT TERM DISABILITY PLAN

2015: SHORT TERM DISABILITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SHORT TERM DISABILITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SHORT TERM DISABILITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SHORT TERM DISABILITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SHORT TERM DISABILITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: SHORT TERM DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

455796

Policy instance

Insurance contract or identification number	455796
Number of Individuals Covered	1224
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $4,052
Total amount of fees paid to insurance company	USD $1,059
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?	Yes
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	Yes
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 $141,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	NON-PARTICIPATING CONTRACT (PREMIUM
Commission paid to Insurance Broker	USD $4,052
Amount paid for insurance broker fees	1059
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MINTZ & VAN NEST INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

455796

Policy instance

Insurance contract or identification number	455796
Number of Individuals Covered	1389
Insurance policy start date	2013-12-01
Insurance policy end date	2014-12-01
Total amount of commissions paid to insurance broker	USD $3,975
Total amount of fees paid to insurance company	USD $1,002
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?	Yes
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	Yes
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 $133,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	NON-PARTICIPATING CONTRACT (PREMIUM
Commission paid to Insurance Broker	USD $3,975
Amount paid for insurance broker fees	1002
Additional information about fees paid to insurance broker	TEMPORARY DISABILITY
Insurance broker organization code?	3
Insurance broker name	MINTZ & VAN NEST INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

455796

Policy instance

Insurance contract or identification number	455796
Number of Individuals Covered	1349
Insurance policy start date	2012-12-01
Insurance policy end date	2013-12-01
Total amount of commissions paid to insurance broker	USD $4,167
Total amount of fees paid to insurance company	USD $1,146
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?	Yes
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	Yes
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 $152,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	NON-PARTICIPATING CONTRACT (PREMIUM
Commission paid to Insurance Broker	USD $4,167
Amount paid for insurance broker fees	1146
Additional information about fees paid to insurance broker	TEMPORARY DISABILITY
Insurance broker organization code?	3
Insurance broker name	MINTZ & VAN NEST INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

455796

Policy instance

Insurance contract or identification number	455796
Number of Individuals Covered	1379
Insurance policy start date	2011-12-01
Insurance policy end date	2012-12-01
Total amount of commissions paid to insurance broker	USD $4,234
Total amount of fees paid to insurance company	USD $1,271
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?	Yes
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	Yes
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 $159,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	NON-PARTICIPATING CONTRACT (PREMIUM
Commission paid to Insurance Broker	USD $4,234
Amount paid for insurance broker fees	1271
Additional information about fees paid to insurance broker	INSURANCE
Insurance broker organization code?	3
Insurance broker name	MINTZ & VAN NEST INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

455796

Policy instance

Insurance contract or identification number	455796
Number of Individuals Covered	1392
Insurance policy start date	2010-12-01
Insurance policy end date	2011-12-01
Total amount of commissions paid to insurance broker	USD $4,614
Total amount of fees paid to insurance company	USD $2,467
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?	Yes
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	Yes
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 $187,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	NON-PARTICIPATING CONTRACT (PREMIUM

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

455796

Policy instance

Insurance contract or identification number	455796
Number of Individuals Covered	1382
Insurance policy start date	2009-12-01
Insurance policy end date	2010-12-01
Total amount of commissions paid to insurance broker	USD $4,045
Total amount of fees paid to insurance company	USD $1,757
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?	Yes
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	Yes
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 $150,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	NON-PARTICIPATING CONTRACT (PREMIUM
Commission paid to Insurance Broker	USD $4,045
Amount paid for insurance broker fees	1757
Additional information about fees paid to insurance broker	INSURANCE
Insurance broker organization code?	3
Insurance broker name	MINTZ & VAN NEST INC.

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Company Name:	DAVIS POLK & WARDWELL LLP
Employer identification number (EIN):	135023295

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2009-06-18
Company Identification Number:	3823719
Legal Registered Office Address:	450 LEXINGTON AVENUE NEW YORK United States of America (USA) 10017