401k Plan data: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY plan

GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 401k Plan overview

Plan Name	GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY
Plan identification number	502

GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

OCCUPATIONAL DEVELOPMENT CENTER INC has sponsored the creation of one or more 401k plans.

Company Name: OCCUPATIONAL DEVELOPMENT CENTER INC

Employer identification number (EIN): 410973895

NAIC Classification: 624310
NAIC Description: Vocational Rehabilitation Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01 NANCY COTA NANCY COTA 2018-07-31
502 2016-01-01 NANCY COTA NANCY COTA 2017-07-27
502 2014-10-01 NANCY COTA NANCY COTA 2016-07-22
502 2013-10-01 NANCY COTA NANCY COTA 2015-03-13
502 2013-07-01 NANCY COTA NANCY COTA 2015-03-13
502 2012-07-01 NANCY COTA NANCY COTA 2014-01-27
502 2011-07-01 NANCY COTA
502 2009-07-01 NANCY COTA

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2017-01-01	NANCY COTA	NANCY COTA	2018-07-31
502	2016-01-01	NANCY COTA	NANCY COTA	2017-07-27
502	2014-10-01	NANCY COTA	NANCY COTA	2016-07-22
502	2013-10-01	NANCY COTA	NANCY COTA	2015-03-13
502	2013-07-01	NANCY COTA	NANCY COTA	2015-03-13
502	2012-07-01	NANCY COTA	NANCY COTA	2014-01-27
502	2011-07-01	NANCY COTA
502	2009-07-01	NANCY COTA

Plan Statistics for GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY

401k plan membership statisitcs for GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY

Measure Date Value
2017: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 115
Total of all active and inactive participants 2017-01-01 115
Total participants 2017-01-01 115
2016: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 117
Number of retired or separated participants receiving benefits 2016-01-01 1
Total of all active and inactive participants 2016-01-01 118
Total participants 2016-01-01 118
2014: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year 2014-10-01 228
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 167
Number of retired or separated participants receiving benefits 2014-10-01 1
Total of all active and inactive participants 2014-10-01 168
Total participants 2014-10-01 168
2013: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year 2013-10-01 206
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 227
Number of other retired or separated participants entitled to future benefits 2013-10-01 1
Total of all active and inactive participants 2013-10-01 228
Total participants 2013-10-01 228
Total participants, beginning-of-year 2013-07-01 173
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 205
Number of other retired or separated participants entitled to future benefits 2013-07-01 1
Total of all active and inactive participants 2013-07-01 206
Total participants 2013-07-01 206
2012: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year 2012-07-01 179
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 172
Number of other retired or separated participants entitled to future benefits 2012-07-01 1
Total of all active and inactive participants 2012-07-01 173
Total participants 2012-07-01 173
2011: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year 2011-07-01 167
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 179
Total of all active and inactive participants 2011-07-01 179
Total participants 2011-07-01 179
2009: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year 2009-07-01 170
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 148
Number of retired or separated participants receiving benefits 2009-07-01 1
Total of all active and inactive participants 2009-07-01 149
Total participants 2009-07-01 149

Measure	Date	Value
2017: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	115
Total of all active and inactive participants	2017-01-01	115
Total participants	2017-01-01	115
2016: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	117
Number of retired or separated participants receiving benefits	2016-01-01	1
Total of all active and inactive participants	2016-01-01	118
Total participants	2016-01-01	118
2014: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year	2014-10-01	228
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	167
Number of retired or separated participants receiving benefits	2014-10-01	1
Total of all active and inactive participants	2014-10-01	168
Total participants	2014-10-01	168
2013: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year	2013-10-01	206
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	227
Number of other retired or separated participants entitled to future benefits	2013-10-01	1
Total of all active and inactive participants	2013-10-01	228
Total participants	2013-10-01	228
Total participants, beginning-of-year	2013-07-01	173
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	205
Number of other retired or separated participants entitled to future benefits	2013-07-01	1
Total of all active and inactive participants	2013-07-01	206
Total participants	2013-07-01	206
2012: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year	2012-07-01	179
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	172
Number of other retired or separated participants entitled to future benefits	2012-07-01	1
Total of all active and inactive participants	2012-07-01	173
Total participants	2012-07-01	173
2011: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year	2011-07-01	167
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	179
Total of all active and inactive participants	2011-07-01	179
Total participants	2011-07-01	179
2009: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year	2009-07-01	170
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	148
Number of retired or separated participants receiving benefits	2009-07-01	1
Total of all active and inactive participants	2009-07-01	149
Total participants	2009-07-01	149

Form 5500 Responses for GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY

2017: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 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 TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 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
2014: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2009: GROUP TERM LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG TERM DISABILITY 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5469010

Policy instance

Insurance contract or identification number	5469010
Number of Individuals Covered	115
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,991
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $82,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,991
Insurance broker organization code?	3
Insurance broker name	NORTH RISK PARTNERS LLC

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Company Name:	OCCUPATIONAL DEVELOPMENT CENTER INC
Employer identification number (EIN):	410973895
NAIC Classification:	624310
NAIC Description:	Vocational Rehabilitation Services