401k Plan data: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. plan

GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 401k Plan overview

Plan Name	GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC.
Plan identification number	503

GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

THE COMMUNITY ACTION ORGANIZATION WESTERN NEW YORK, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE COMMUNITY ACTION ORGANIZATION WESTERN NEW YORK, INC.

Employer identification number (EIN): 160911473

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2019-01-01 DEANNE MONTGOMERY 2021-05-24
503 2018-01-01
503 2017-01-01 DEANNE MONTGOMERY
503 2016-01-01 DEANNE MONTGOMERY
503 2015-01-01 DEANNE MONTGOMERY
503 2014-01-01 DEANNE MONTGOMERY
503 2013-01-01 DEANNE MONTGOMERY
503 2012-01-01 JENNIFER O'BRIEN JENNIFER O'BRIEN 2013-04-01
503 2011-01-01 MARGARET KRATHAUS
503 2009-01-01 MARGARET KRATHAUS
503 2008-01-01 MARGARET KRATHAUS
503 2007-01-01 MARGARET KRATHAUS
503 2006-01-01 MARGARET KRATHAUS
503 2005-01-01 MARGARET KRATHAUS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2019-01-01	DEANNE MONTGOMERY	2021-05-24
503	2018-01-01
503	2017-01-01	DEANNE MONTGOMERY
503	2016-01-01	DEANNE MONTGOMERY
503	2015-01-01	DEANNE MONTGOMERY
503	2014-01-01	DEANNE MONTGOMERY
503	2013-01-01	DEANNE MONTGOMERY
503	2012-01-01	JENNIFER O'BRIEN		JENNIFER O'BRIEN	2013-04-01
503	2011-01-01	MARGARET KRATHAUS
503	2009-01-01	MARGARET KRATHAUS
503	2008-01-01	MARGARET KRATHAUS
503	2007-01-01	MARGARET KRATHAUS
503	2006-01-01	MARGARET KRATHAUS
503	2005-01-01	MARGARET KRATHAUS

Plan Statistics for GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC.

401k plan membership statisitcs for GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC.

Measure Date Value
2019: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of employers contributing to the scheme 2019-01-01 0
2018: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 540
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 664
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 664
2017: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 540
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 540
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 540
2016: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 446
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 512
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 512
2015: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 328
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 446
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 2015-01-01 446
2014: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 292
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 328
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 2014-01-01 328
2013: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 351
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 329
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 2013-01-01 329
2012: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 299
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 305
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 2012-01-01 305
2011: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 308
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 299
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 2011-01-01 299
2009: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 264
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 302
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 2009-01-01 302
2008: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2008 401k membership
Total participants, beginning-of-year 2008-01-01 261
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 264
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 264
2007: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2007 401k membership
Total participants, beginning-of-year 2007-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 261
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 0
Total of all active and inactive participants 2007-01-01 261
2006: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2006 401k membership
Total participants, beginning-of-year 2006-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 246
Number of retired or separated participants receiving benefits 2006-01-01 0
Number of other retired or separated participants entitled to future benefits 2006-01-01 0
Total of all active and inactive participants 2006-01-01 246
2005: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2005 401k membership
Total participants, beginning-of-year 2005-01-01 268
Total number of active participants reported on line 7a of the Form 5500 2005-01-01 275
Number of retired or separated participants receiving benefits 2005-01-01 0
Number of other retired or separated participants entitled to future benefits 2005-01-01 0
Total of all active and inactive participants 2005-01-01 275

Measure	Date	Value
2019: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of employers contributing to the scheme	2019-01-01	0
2018: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	540
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	664
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	664
2017: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	540
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	540
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	540
2016: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	446
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	512
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	512
2015: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	328
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	446
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	446
2014: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	292
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	328
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	328
2013: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	351
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	329
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	329
2012: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	299
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	305
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	305
2011: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	308
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	299
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	299
2009: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	264
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	302
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	302
2008: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2008 401k membership
Total participants, beginning-of-year	2008-01-01	261
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	264
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	264
2007: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2007 401k membership
Total participants, beginning-of-year	2007-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	261
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	0
Total of all active and inactive participants	2007-01-01	261
2006: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2006 401k membership
Total participants, beginning-of-year	2006-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	246
Number of retired or separated participants receiving benefits	2006-01-01	0
Number of other retired or separated participants entitled to future benefits	2006-01-01	0
Total of all active and inactive participants	2006-01-01	246
2005: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2005 401k membership
Total participants, beginning-of-year	2005-01-01	268
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	275
Number of retired or separated participants receiving benefits	2005-01-01	0
Number of other retired or separated participants entitled to future benefits	2005-01-01	0
Total of all active and inactive participants	2005-01-01	275

Form 5500 Responses for GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC.

2019: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 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	No
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: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 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: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
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: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 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: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 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: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 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
2008: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2007: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2006: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2005: GROUP DISABILITY INCOME PLAN OF COMMUNITY ACTION ORGANIZATION OF ERIE COUNTY, INC. 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – Insurance	Yes
2005-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

465476

Policy instance

Insurance contract or identification number	465476
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

465476

Policy instance

Insurance contract or identification number	465476
Number of Individuals Covered	664
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,494
Total amount of fees paid to insurance company	USD $169
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $90,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,711
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMPENSATION PAID FOR PLACEMENT AND MANGEMENT OF INSURANCE PRODUCTS
Insurance broker organization code?	3

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

Policy contract number

465476

Policy instance

Insurance contract or identification number	465476
Number of Individuals Covered	540
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,527
Total amount of fees paid to insurance company	USD $646
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $51,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,527
Amount paid for insurance broker fees	646
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK INC.

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Company Name:	THE COMMUNITY ACTION ORGANIZATION WESTERN NEW YORK, INC.
Employer identification number (EIN):	160911473
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations