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ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 401k Plan overview

Plan NameADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT
Plan identification number 555

ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT Benefits

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

401k Sponsoring company profile

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

Company Name:ADELPHI UNIVERSITY
Employer identification number (EIN):111630741
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5552022-01-01
5552021-01-01
5552020-01-01
5552019-01-01
5552018-01-01JOANNA OCAMPO KAREN LOIACONO2019-07-09
5552017-01-01LORA-JEAN DENICOLA KAREN LOIACONO2018-07-11
5552016-01-01JOANNA OCAMPO KAREN LOIACONO2017-07-21
5552015-01-01KAREN LOIACONO KAREN LOIACONO2016-07-06
5552014-01-01KAREN LOIACONO KAREN LOIACONO2015-07-08
5552012-12-31KAREN LOIACONO LISA ARAUJO2014-07-24
5552011-12-31KAREN LOIACONO LISA ARAUJO2013-07-19
5552009-12-31KAREN LOIACONO LISA ARAUJO2011-06-17
5552008-12-31KAREN LOIACONO LISA ARAUJO2010-09-16

Plan Statistics for ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT

401k plan membership statisitcs for ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT

Measure Date Value
2022: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2022 401k membership
Total participants, beginning-of-year2022-01-011,118
Total number of active participants reported on line 7a of the Form 55002022-01-011,165
Total of all active and inactive participants2022-01-011,165
Total participants2022-01-011,165
2021: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2021 401k membership
Total participants, beginning-of-year2021-01-011,091
Total number of active participants reported on line 7a of the Form 55002021-01-011,118
Total of all active and inactive participants2021-01-011,118
Total participants2021-01-011,118
2020: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2020 401k membership
Total participants, beginning-of-year2020-01-011,506
Total number of active participants reported on line 7a of the Form 55002020-01-011,091
Total of all active and inactive participants2020-01-011,091
Total participants2020-01-011,091
2019: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2019 401k membership
Total participants, beginning-of-year2019-01-011,245
Total number of active participants reported on line 7a of the Form 55002019-01-011,506
Total of all active and inactive participants2019-01-011,506
Total participants2019-01-011,506
2018: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2018 401k membership
Total participants, beginning-of-year2018-01-011,975
Total number of active participants reported on line 7a of the Form 55002018-01-012,291
Total of all active and inactive participants2018-01-012,291
Total participants2018-01-012,291
2017: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2017 401k membership
Total participants, beginning-of-year2017-01-012,194
Total number of active participants reported on line 7a of the Form 55002017-01-011,975
Total of all active and inactive participants2017-01-011,975
Total participants2017-01-011,975
2016: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2016 401k membership
Total participants, beginning-of-year2016-01-012,179
Total number of active participants reported on line 7a of the Form 55002016-01-011,914
Total of all active and inactive participants2016-01-011,914
Total participants2016-01-011,914
2015: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2015 401k membership
Total participants, beginning-of-year2015-01-012,121
Total number of active participants reported on line 7a of the Form 55002015-01-011,910
Total of all active and inactive participants2015-01-011,910
Total participants2015-01-011,910
2014: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2014 401k membership
Total participants, beginning-of-year2014-01-011,931
Total number of active participants reported on line 7a of the Form 55002014-01-012,121
Total of all active and inactive participants2014-01-012,121
Total participants2014-01-012,121
2012: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2012 401k membership
Total participants, beginning-of-year2012-12-312,104
Total number of active participants reported on line 7a of the Form 55002012-12-312,133
Total of all active and inactive participants2012-12-312,133
Total participants2012-12-312,133
2011: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2011 401k membership
Total participants, beginning-of-year2011-12-312,012
Total number of active participants reported on line 7a of the Form 55002011-12-312,104
Total of all active and inactive participants2011-12-312,104
Total participants2011-12-312,104
2009: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2009 401k membership
Total participants, beginning-of-year2009-12-312,000
Total number of active participants reported on line 7a of the Form 55002009-12-312,100
Total of all active and inactive participants2009-12-312,100
Total participants2009-12-312,100
2008: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2008 401k membership
Total participants, beginning-of-year2008-12-312,000
Total number of active participants reported on line 7a of the Form 55002008-12-312,000
Total of all active and inactive participants2008-12-312,000
Total participants2008-12-312,000

Form 5500 Responses for ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT

2022: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2012: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2012 form 5500 responses
2012-12-31Type of plan entitySingle employer plan
2012-12-31Submission has been amendedNo
2012-12-31This submission is the final filingNo
2012-12-31This return/report is a short plan year return/report (less than 12 months)No
2012-12-31Plan is a collectively bargained planYes
2012-12-31Plan funding arrangement – InsuranceYes
2012-12-31Plan benefit arrangement – InsuranceYes
2011: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2011 form 5500 responses
2011-12-31Type of plan entitySingle employer plan
2011-12-31Submission has been amendedNo
2011-12-31This submission is the final filingNo
2011-12-31This return/report is a short plan year return/report (less than 12 months)No
2011-12-31Plan is a collectively bargained planYes
2011-12-31Plan funding arrangement – InsuranceYes
2011-12-31Plan benefit arrangement – InsuranceYes
2009: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2009 form 5500 responses
2009-12-31Type of plan entitySingle employer plan
2009-12-31Submission has been amendedNo
2009-12-31This submission is the final filingNo
2009-12-31This return/report is a short plan year return/report (less than 12 months)No
2009-12-31Plan is a collectively bargained planYes
2009-12-31Plan funding arrangement – InsuranceYes
2009-12-31Plan benefit arrangement – InsuranceYes
2008: ADELPHI UNIVERSITY GROUP BUSINESS TRAVEL ACCIDENT 2008 form 5500 responses
2008-12-31Type of plan entitySingle employer plan
2008-12-31Submission has been amendedNo
2008-12-31This submission is the final filingNo
2008-12-31This return/report is a short plan year return/report (less than 12 months)No
2008-12-31Plan is a collectively bargained planYes
2008-12-31Plan funding arrangement – InsuranceYes
2008-12-31Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number9906-6506
Policy instance 1
Insurance contract or identification number9906-6506
Number of Individuals Covered1165
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $717
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number9906-6506
Policy instance 1
Insurance contract or identification number9906-6506
Number of Individuals Covered1118
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,589
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: 20281 )
Policy contract number9906-6506
Policy instance 1
Insurance contract or identification number9906-6506
Number of Individuals Covered1091
Insurance policy start date2020-01-01
Insurance policy end date2020-12-21
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $717
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered1506
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $649
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered2291
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $649
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $649
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered1975
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $650
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $650
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameREUBEN WARNER ASSOCIATES
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered1910
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $472
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $472
Insurance broker organization code?3
Insurance broker nameREUBEN WARNER ASSOCIATES, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered2121
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $472
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $472
Insurance broker organization code?3
Insurance broker nameREUBEN WARNER ASSOCIATES, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered2133
Insurance policy start date2012-12-31
Insurance policy end date2013-12-30
Total amount of commissions paid to insurance brokerUSD $395
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $395
Insurance broker organization code?3
Insurance broker nameREUBEN WARNER ASSOCIATES, INC
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered2104
Insurance policy start date2011-12-31
Insurance policy end date2012-12-30
Total amount of commissions paid to insurance brokerUSD $407
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,360
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: 20281 )
Policy contract number000099066506
Policy instance 1
Insurance contract or identification number000099066506
Number of Individuals Covered2012
Insurance policy start date2010-12-31
Insurance policy end date2011-12-30
Total amount of commissions paid to insurance brokerUSD $407
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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