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NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 401k Plan overview

Plan NameNEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN
Plan identification number 502

NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 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

NEW YORK LIFE INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:NEW YORK LIFE INSURANCE COMPANY
Employer identification number (EIN):135582869
NAIC Classification:523900

Additional information about NEW YORK LIFE INSURANCE COMPANY

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 571930

More information about NEW YORK LIFE INSURANCE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-04-24
5022021-04-24
5022020-04-24
5022019-04-24
5022018-04-24
5022017-04-24MARIA J. MAUCERI
5022016-04-24MARIA J. MAUCERI
5022016-04-24MARIA J. MAUCERI2017-10-06
5022015-04-24MARIA J. MAUCERI MARIA J. MAUCERI2016-10-12
5022014-04-24MARIA J. MAUCERI MARIA J. MAUCERI2015-10-15
5022013-04-24MARIA J. MAUCERI MARIA J. MAUCERI2014-10-15
5022012-04-24MARIA J. MAUCERI MARIA J. MAUCERI2013-10-08
5022011-04-24MARIA J. MAUCERI MARIA J. MAUCERI2012-10-10
5022009-04-24MARIA J. MAUCERI MARIA J. MAUCERI2010-10-13

Plan Statistics for NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN

401k plan membership statisitcs for NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN

Measure Date Value
2022: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-2411,952
Total number of active participants reported on line 7a of the Form 55002022-04-2412,538
Total of all active and inactive participants2022-04-2412,538
2021: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-249,047
Total number of active participants reported on line 7a of the Form 55002021-04-2411,952
Total of all active and inactive participants2021-04-2411,952
2020: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-248,940
Total number of active participants reported on line 7a of the Form 55002020-04-249,047
Total of all active and inactive participants2020-04-249,047
2019: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-248,891
Total number of active participants reported on line 7a of the Form 55002019-04-248,940
Total of all active and inactive participants2019-04-248,940
2018: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-248,665
Total number of active participants reported on line 7a of the Form 55002018-04-248,891
Number of retired or separated participants receiving benefits2018-04-240
Number of other retired or separated participants entitled to future benefits2018-04-240
Total of all active and inactive participants2018-04-248,891
2017: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-248,551
Total number of active participants reported on line 7a of the Form 55002017-04-248,665
Number of retired or separated participants receiving benefits2017-04-240
Number of other retired or separated participants entitled to future benefits2017-04-240
Total of all active and inactive participants2017-04-248,665
2016: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-248,980
Total number of active participants reported on line 7a of the Form 55002016-04-248,851
Number of other retired or separated participants entitled to future benefits2016-04-240
Total of all active and inactive participants2016-04-248,851
2015: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-249,078
Total number of active participants reported on line 7a of the Form 55002015-04-248,980
Number of retired or separated participants receiving benefits2015-04-240
Number of other retired or separated participants entitled to future benefits2015-04-240
Total of all active and inactive participants2015-04-248,980
2014: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-249,020
Total number of active participants reported on line 7a of the Form 55002014-04-249,078
Number of retired or separated participants receiving benefits2014-04-240
Number of other retired or separated participants entitled to future benefits2014-04-240
Total of all active and inactive participants2014-04-249,078
2013: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-249,250
Total number of active participants reported on line 7a of the Form 55002013-04-249,020
Number of retired or separated participants receiving benefits2013-04-240
Number of other retired or separated participants entitled to future benefits2013-04-240
Total of all active and inactive participants2013-04-249,020
2012: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-249,300
Total number of active participants reported on line 7a of the Form 55002012-04-249,250
Number of retired or separated participants receiving benefits2012-04-240
Number of other retired or separated participants entitled to future benefits2012-04-240
Total of all active and inactive participants2012-04-249,250
2011: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-249,271
Total number of active participants reported on line 7a of the Form 55002011-04-249,253
Number of retired or separated participants receiving benefits2011-04-240
Number of other retired or separated participants entitled to future benefits2011-04-240
Total of all active and inactive participants2011-04-249,253
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-04-240
2009: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-249,106
Total number of active participants reported on line 7a of the Form 55002009-04-249,236
Number of retired or separated participants receiving benefits2009-04-240
Number of other retired or separated participants entitled to future benefits2009-04-240
Total of all active and inactive participants2009-04-249,236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-04-240

Form 5500 Responses for NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN

2022: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2022 form 5500 responses
2022-04-24Type of plan entitySingle employer plan
2022-04-24Submission has been amendedNo
2022-04-24This submission is the final filingNo
2022-04-24This return/report is a short plan year return/report (less than 12 months)No
2022-04-24Plan is a collectively bargained planNo
2022-04-24Plan funding arrangement – InsuranceYes
2022-04-24Plan benefit arrangement – InsuranceYes
2021: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2021 form 5500 responses
2021-04-24Type of plan entitySingle employer plan
2021-04-24Submission has been amendedNo
2021-04-24This submission is the final filingNo
2021-04-24This return/report is a short plan year return/report (less than 12 months)No
2021-04-24Plan is a collectively bargained planNo
2021-04-24Plan funding arrangement – InsuranceYes
2021-04-24Plan benefit arrangement – InsuranceYes
2020: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2020 form 5500 responses
2020-04-24Type of plan entitySingle employer plan
2020-04-24Submission has been amendedNo
2020-04-24This submission is the final filingNo
2020-04-24This return/report is a short plan year return/report (less than 12 months)No
2020-04-24Plan is a collectively bargained planNo
2020-04-24Plan funding arrangement – InsuranceYes
2020-04-24Plan benefit arrangement – InsuranceYes
2019: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2019 form 5500 responses
2019-04-24Type of plan entitySingle employer plan
2019-04-24Submission has been amendedNo
2019-04-24This submission is the final filingNo
2019-04-24This return/report is a short plan year return/report (less than 12 months)No
2019-04-24Plan is a collectively bargained planNo
2019-04-24Plan funding arrangement – InsuranceYes
2019-04-24Plan benefit arrangement – InsuranceYes
2018: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2018 form 5500 responses
2018-04-24Type of plan entitySingle employer plan
2018-04-24Submission has been amendedNo
2018-04-24This submission is the final filingNo
2018-04-24This return/report is a short plan year return/report (less than 12 months)No
2018-04-24Plan is a collectively bargained planNo
2018-04-24Plan funding arrangement – InsuranceYes
2018-04-24Plan benefit arrangement – InsuranceYes
2017: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2017 form 5500 responses
2017-04-24Type of plan entitySingle employer plan
2017-04-24Submission has been amendedNo
2017-04-24This submission is the final filingNo
2017-04-24This return/report is a short plan year return/report (less than 12 months)No
2017-04-24Plan is a collectively bargained planNo
2017-04-24Plan funding arrangement – InsuranceYes
2017-04-24Plan benefit arrangement – InsuranceYes
2016: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2016 form 5500 responses
2016-04-24Type of plan entitySingle employer plan
2016-04-24Submission has been amendedYes
2016-04-24This submission is the final filingNo
2016-04-24This return/report is a short plan year return/report (less than 12 months)No
2016-04-24Plan is a collectively bargained planNo
2016-04-24Plan funding arrangement – InsuranceYes
2016-04-24Plan benefit arrangement – InsuranceYes
2015: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2015 form 5500 responses
2015-04-24Type of plan entitySingle employer plan
2015-04-24Submission has been amendedNo
2015-04-24This submission is the final filingNo
2015-04-24This return/report is a short plan year return/report (less than 12 months)No
2015-04-24Plan is a collectively bargained planNo
2015-04-24Plan funding arrangement – InsuranceYes
2015-04-24Plan benefit arrangement – InsuranceYes
2014: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2014 form 5500 responses
2014-04-24Type of plan entitySingle employer plan
2014-04-24Submission has been amendedNo
2014-04-24This submission is the final filingNo
2014-04-24This return/report is a short plan year return/report (less than 12 months)No
2014-04-24Plan is a collectively bargained planNo
2014-04-24Plan funding arrangement – InsuranceYes
2014-04-24Plan benefit arrangement – InsuranceYes
2013: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2013 form 5500 responses
2013-04-24Type of plan entitySingle employer plan
2013-04-24Submission has been amendedNo
2013-04-24This submission is the final filingNo
2013-04-24This return/report is a short plan year return/report (less than 12 months)No
2013-04-24Plan is a collectively bargained planNo
2013-04-24Plan funding arrangement – InsuranceYes
2013-04-24Plan benefit arrangement – InsuranceYes
2012: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2012 form 5500 responses
2012-04-24Type of plan entitySingle employer plan
2012-04-24Submission has been amendedNo
2012-04-24This submission is the final filingNo
2012-04-24This return/report is a short plan year return/report (less than 12 months)No
2012-04-24Plan is a collectively bargained planNo
2012-04-24Plan funding arrangement – InsuranceYes
2012-04-24Plan benefit arrangement – InsuranceYes
2011: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2011 form 5500 responses
2011-04-24Type of plan entitySingle employer plan
2011-04-24Submission has been amendedNo
2011-04-24This submission is the final filingNo
2011-04-24This return/report is a short plan year return/report (less than 12 months)No
2011-04-24Plan is a collectively bargained planNo
2011-04-24Plan funding arrangement – InsuranceYes
2011-04-24Plan benefit arrangement – InsuranceYes
2009: NEW YORK LIFE INSURANCE COMPANY TRAVEL ACCIDENT PLAN 2009 form 5500 responses
2009-04-24Type of plan entitySingle employer plan
2009-04-24Submission has been amendedNo
2009-04-24This submission is the final filingNo
2009-04-24This return/report is a short plan year return/report (less than 12 months)No
2009-04-24Plan is a collectively bargained planNo
2009-04-24Plan funding arrangement – InsuranceYes
2009-04-24Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered12538
Insurance policy start date2022-04-24
Insurance policy end date2023-04-23
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 providedTRAVEL ACCIDENT INSURANCE
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 $5,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered11952
Insurance policy start date2021-04-24
Insurance policy end date2022-04-23
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 providedTRAVEL ACCIDENT INSURANCE
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 $7,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered8940
Insurance policy start date2020-04-24
Insurance policy end date2021-04-23
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 providedTRAVEL ACCIDENT INSURANCE
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 $59,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered8940
Insurance policy start date2019-04-24
Insurance policy end date2020-04-23
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 providedTRAVEL ACCIDENT INSURANCE
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 $7,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered8891
Insurance policy start date2018-04-24
Insurance policy end date2019-04-23
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 providedTRAVEL ACCIDENT INSURANCE
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 $24,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered8665
Insurance policy start date2017-04-24
Insurance policy end date2018-04-23
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 providedTRAVEL ACCIDENT INSURANCE
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 $24,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered8980
Insurance policy start date2015-04-24
Insurance policy end date2016-04-23
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?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 providedTRAVEL ACCIDENT INSURANCE
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 $19,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU 5466165
Policy instance 1
Insurance contract or identification numberGTU 5466165
Number of Individuals Covered9078
Insurance policy start date2014-04-24
Insurance policy end date2015-04-23
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?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 providedTRAVEL ACCIDENT INSURANCE
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 $19,789
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 number99069979
Policy instance 1
Insurance contract or identification number99069979
Number of Individuals Covered9020
Insurance policy start date2013-04-24
Insurance policy end date2014-04-23
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?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 providedTRAVEL ACCIDENT INSURANCE
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 $15,815
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 number99069979
Policy instance 1
Insurance contract or identification number99069979
Number of Individuals Covered9250
Insurance policy start date2012-04-24
Insurance policy end date2013-04-23
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?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 providedTRAVEL ACCIDENT INSURANCE
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 $46,000
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 number99069979
Policy instance 1
Insurance contract or identification number99069979
Number of Individuals Covered9300
Insurance policy start date2011-04-24
Insurance policy end date2012-04-23
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?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 providedTRAVEL ACCIDENT INSURANCE
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 $47,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB001557
Policy instance 1
Insurance contract or identification numberETB001557
Number of Individuals Covered9300
Insurance policy start date2010-04-24
Insurance policy end date2011-04-23
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?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 providedTRAVEL ACCIDENT INSURANCE
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 $25,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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