CORNELL DUBILIER ELECTRONICS, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2021: TRAVEL ACCIDENT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 1,025 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 1,000 |
| Total of all active and inactive participants | 2021-09-01 | 1,000 |
| Total participants | 2021-09-01 | 1,000 |
| 2020: TRAVEL ACCIDENT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 820 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 1,025 |
| Total of all active and inactive participants | 2020-09-01 | 1,025 |
| Total participants | 2020-09-01 | 1,025 |
| 2019: TRAVEL ACCIDENT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 740 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 820 |
| Total of all active and inactive participants | 2019-09-01 | 820 |
| Total participants | 2019-09-01 | 820 |
| 2018: TRAVEL ACCIDENT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-31 | 500 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-31 | 740 |
| Total of all active and inactive participants | 2018-08-31 | 740 |
| Total participants | 2018-08-31 | 740 |
| 2017: TRAVEL ACCIDENT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 500 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 500 |
| Total of all active and inactive participants | 2017-09-01 | 500 |
| Total participants | 2017-09-01 | 500 |
| 2016: TRAVEL ACCIDENT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-31 | 500 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-31 | 500 |
| Total of all active and inactive participants | 2016-08-31 | 500 |
| Total participants | 2016-08-31 | 500 |
| 2015: TRAVEL ACCIDENT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-31 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-31 | 240 |
| Total of all active and inactive participants | 2015-08-31 | 240 |
| Total participants | 2015-08-31 | 240 |
| 2014: TRAVEL ACCIDENT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-31 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-31 | 240 |
| Total of all active and inactive participants | 2014-08-31 | 240 |
| Total participants | 2014-08-31 | 240 |
| 2013: TRAVEL ACCIDENT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-31 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-31 | 240 |
| Total of all active and inactive participants | 2013-08-31 | 240 |
| Total participants | 2013-08-31 | 240 |
| 2012: TRAVEL ACCIDENT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 240 |
| Total of all active and inactive participants | 2012-09-01 | 240 |
| Total participants | 2012-09-01 | 240 |
| 2011: TRAVEL ACCIDENT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 240 |
| Total of all active and inactive participants | 2011-09-01 | 240 |
| Total participants | 2011-09-01 | 240 |
| 2010: TRAVEL ACCIDENT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-09-01 | 310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 340 |
| Total of all active and inactive participants | 2010-09-01 | 340 |
| Total participants | 2010-09-01 | 340 |
| 2009: TRAVEL ACCIDENT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 310 |
| Total of all active and inactive participants | 2009-09-01 | 310 |
| Total participants | 2009-09-01 | 310 |
| 2008: TRAVEL ACCIDENT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-09-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-09-01 | 250 |
| Total of all active and inactive participants | 2008-09-01 | 250 |
| Total participants | 2008-09-01 | 250 |
| 2021: TRAVEL ACCIDENT PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Submission has been amended | No |
| 2021-09-01 | This submission is the final filing | No |
| 2021-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-09-01 | Plan is a collectively bargained plan | No |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: TRAVEL ACCIDENT PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Submission has been amended | No |
| 2020-09-01 | This submission is the final filing | No |
| 2020-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-09-01 | Plan is a collectively bargained plan | No |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: TRAVEL ACCIDENT PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Submission has been amended | No |
| 2019-09-01 | This submission is the final filing | No |
| 2019-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-09-01 | Plan is a collectively bargained plan | No |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: TRAVEL ACCIDENT PLAN 2018 form 5500 responses |
|---|
| 2018-08-31 | Type of plan entity | Single employer plan |
| 2018-08-31 | Submission has been amended | No |
| 2018-08-31 | This submission is the final filing | No |
| 2018-08-31 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-08-31 | Plan is a collectively bargained plan | No |
| 2018-08-31 | Plan funding arrangement – Insurance | Yes |
| 2018-08-31 | Plan benefit arrangement – Insurance | Yes |
| 2017: TRAVEL ACCIDENT PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Submission has been amended | No |
| 2017-09-01 | This submission is the final filing | No |
| 2017-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-09-01 | Plan is a collectively bargained plan | No |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: TRAVEL ACCIDENT PLAN 2016 form 5500 responses |
|---|
| 2016-08-31 | Type of plan entity | Single employer plan |
| 2016-08-31 | Submission has been amended | No |
| 2016-08-31 | This submission is the final filing | No |
| 2016-08-31 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-08-31 | Plan is a collectively bargained plan | No |
| 2016-08-31 | Plan funding arrangement – Insurance | Yes |
| 2016-08-31 | Plan benefit arrangement – Insurance | Yes |
| 2015: TRAVEL ACCIDENT PLAN 2015 form 5500 responses |
|---|
| 2015-08-31 | Type of plan entity | Single employer plan |
| 2015-08-31 | Submission has been amended | No |
| 2015-08-31 | This submission is the final filing | No |
| 2015-08-31 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-08-31 | Plan is a collectively bargained plan | No |
| 2015-08-31 | Plan funding arrangement – Insurance | Yes |
| 2015-08-31 | Plan benefit arrangement – Insurance | Yes |
| 2014: TRAVEL ACCIDENT PLAN 2014 form 5500 responses |
|---|
| 2014-08-31 | Type of plan entity | Single employer plan |
| 2014-08-31 | Submission has been amended | No |
| 2014-08-31 | This submission is the final filing | No |
| 2014-08-31 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-08-31 | Plan is a collectively bargained plan | No |
| 2014-08-31 | Plan funding arrangement – Insurance | Yes |
| 2014-08-31 | Plan benefit arrangement – Insurance | Yes |
| 2013: TRAVEL ACCIDENT PLAN 2013 form 5500 responses |
|---|
| 2013-08-31 | Type of plan entity | Single employer plan |
| 2013-08-31 | Submission has been amended | No |
| 2013-08-31 | This submission is the final filing | No |
| 2013-08-31 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-08-31 | Plan is a collectively bargained plan | No |
| 2013-08-31 | Plan funding arrangement – Insurance | Yes |
| 2013-08-31 | Plan benefit arrangement – Insurance | Yes |
| 2012: TRAVEL ACCIDENT PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Submission has been amended | No |
| 2012-09-01 | This submission is the final filing | No |
| 2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-09-01 | Plan is a collectively bargained plan | No |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: TRAVEL ACCIDENT PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Submission has been amended | No |
| 2011-09-01 | This submission is the final filing | No |
| 2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-09-01 | Plan is a collectively bargained plan | No |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: TRAVEL ACCIDENT PLAN 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Submission has been amended | No |
| 2010-09-01 | This submission is the final filing | No |
| 2010-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-09-01 | Plan is a collectively bargained plan | No |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: TRAVEL ACCIDENT PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | Yes |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-09-01 | Plan is a collectively bargained plan | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: TRAVEL ACCIDENT PLAN 2008 form 5500 responses |
|---|
| 2008-09-01 | Type of plan entity | Single employer plan |
| 2008-09-01 | Submission has been amended | No |
| 2008-09-01 | This submission is the final filing | No |
| 2008-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-09-01 | Plan is a collectively bargained plan | No |
| 2008-09-01 | Plan funding arrangement – Insurance | Yes |
| 2008-09-01 | Plan benefit arrangement – Insurance | Yes |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 9908-81-70 |
| Policy instance | 1 |
| Insurance contract or identification number | 9908-81-70 | | Number of Individuals Covered | 1000 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $599 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $3,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $599 | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 9908-81-70 |
| Policy instance | 1 |
| Insurance contract or identification number | 9908-81-70 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $288 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $288 | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 9907-37-28 |
| Policy instance | 1 |
| Insurance contract or identification number | 9907-37-28 | | Number of Individuals Covered | 820 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $289 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 0099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 0099063728 | | Number of Individuals Covered | 740 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $289 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 000099063728 | | Number of Individuals Covered | 500 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 000099063728 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2015-08-31 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | 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 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $289 | | Insurance broker organization code? | 3 | | Insurance broker name | BBANDT INSURANCE SERVICES, INC. |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 000099063728 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2014-08-31 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | 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 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $289 | | Amount paid for insurance broker fees | 164 | | Additional information about fees paid to insurance broker | GUARANTEED SUPPLEMENTAL COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES USA |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 000099063728 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2013-08-31 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | 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 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $289 | | Amount paid for insurance broker fees | 164 | | Additional information about fees paid to insurance broker | GUARANTEED SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES USA, |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 000099063728 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2012-08-31 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | 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 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | 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 $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $289 | | Amount paid for insurance broker fees | 53 | | Additional information about fees paid to insurance broker | GUARANTEED SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES INC |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 000099063728 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2011-08-31 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 000099063728 |
| Policy instance | 1 |
| Insurance contract or identification number | 000099063728 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2010-08-31 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $289 | | Other welfare benefits provided | TRAVEL ACCIDENT PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
