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ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 401k Plan overview

Plan NameACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP
Plan identification number 504

ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP Benefits

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

401k Sponsoring company profile

PATTERSON BELKNAP WEBB & TYLER LLP has sponsored the creation of one or more 401k plans.

Company Name:PATTERSON BELKNAP WEBB & TYLER LLP
Employer identification number (EIN):135622951
NAIC Classification:541110
NAIC Description:Offices of Lawyers

Additional information about PATTERSON BELKNAP WEBB & TYLER LLP

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1994-12-30
Company Identification Number: 1880415
Legal Registered Office Address: ATTN: MANAGING PTNR & EXE DIR
1133 AVENUE OF THE AMERICAS
NEW YORK
United States of America (USA)
10036

More information about PATTERSON BELKNAP WEBB & TYLER LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042023-01-01CAROL TAGGART2024-10-11
5042022-01-01CAROL TAGGART2023-10-02
5042021-01-01LORRAINE M. REINA2022-10-13
5042020-01-01LORRAINE M. REINA2021-08-18
5042019-01-01
5042018-01-01
5042017-01-01LORRAINE M. REINA
5042016-01-01LORRAINE M. REINA
5042015-01-01LORRAINE M. REINA
5042014-01-01LORRAINE M. REINA
5042013-01-01LORRAINE M. REINA
5042012-01-01LORRAINE M. REINA
5042011-01-01LORRAINE M. REINA
5042010-01-01LORRAINE M. REINA
5042009-01-01LORRAINE M. REINA
5042009-01-01

Plan Statistics for ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP

401k plan membership statisitcs for ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP

Measure Date Value
2023: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2023 401k membership
Total participants, beginning-of-year2023-01-01321
Total number of active participants reported on line 7a of the Form 55002023-01-010
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-010
Number of employers contributing to the scheme2023-01-010
2022: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2022 401k membership
Total participants, beginning-of-year2022-01-01300
Total number of active participants reported on line 7a of the Form 55002022-01-01321
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01321
Number of employers contributing to the scheme2022-01-010
2021: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2021 401k membership
Total participants, beginning-of-year2021-01-01327
Total number of active participants reported on line 7a of the Form 55002021-01-01300
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01300
Number of employers contributing to the scheme2021-01-010
2020: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2020 401k membership
Total participants, beginning-of-year2020-01-01349
Total number of active participants reported on line 7a of the Form 55002020-01-01327
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01327
Number of employers contributing to the scheme2020-01-010
2019: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2019 401k membership
Total participants, beginning-of-year2019-01-01345
Total number of active participants reported on line 7a of the Form 55002019-01-01349
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01349
2018: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2018 401k membership
Total participants, beginning-of-year2018-01-01345
Total number of active participants reported on line 7a of the Form 55002018-01-01345
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01345
2017: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2017 401k membership
Total participants, beginning-of-year2017-01-01347
Total number of active participants reported on line 7a of the Form 55002017-01-01345
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01345
2016: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2016 401k membership
Total participants, beginning-of-year2016-01-01351
Total number of active participants reported on line 7a of the Form 55002016-01-01347
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01347
2015: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2015 401k membership
Total participants, beginning-of-year2015-01-01348
Total number of active participants reported on line 7a of the Form 55002015-01-01351
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01351
2014: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2014 401k membership
Total participants, beginning-of-year2014-01-01379
Total number of active participants reported on line 7a of the Form 55002014-01-01348
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01348
2013: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2013 401k membership
Total participants, beginning-of-year2013-01-01383
Total number of active participants reported on line 7a of the Form 55002013-01-01379
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01379
2012: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2012 401k membership
Total participants, beginning-of-year2012-01-01383
Total number of active participants reported on line 7a of the Form 55002012-01-01383
Total of all active and inactive participants2012-01-01383
2011: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2011 401k membership
Total participants, beginning-of-year2011-01-01390
Total number of active participants reported on line 7a of the Form 55002011-01-01383
Total of all active and inactive participants2011-01-01383
2010: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2010 401k membership
Total participants, beginning-of-year2010-01-01368
Total number of active participants reported on line 7a of the Form 55002010-01-01390
Total of all active and inactive participants2010-01-01390
2009: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2009 401k membership
Total participants, beginning-of-year2009-01-01372
Total number of active participants reported on line 7a of the Form 55002009-01-01368
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01368

Form 5500 Responses for ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP

2023: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01This submission is the final filingYes
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 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 planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 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 planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 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 planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 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 planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 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 planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 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 planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: ACCIDENTAL DEATH & INJURY PLAN FOR PARTNERS AND EMPLOYEES OF PATTERSON BELKNAP WEBB & TYLER LLP 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered321
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $22,324
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 number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered321
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
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $0
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 number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered300
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $0
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 number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered327
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,769
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $25,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $3,884
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered349
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,632
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 $8,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,316
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered345
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,632
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 $8,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,316
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered345
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,866
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 $9,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,433
Insurance broker organization code?3
Insurance broker nameMMG AGENCY INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered351
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,894
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 $9,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,447
Insurance broker organization code?3
Insurance broker nameM.M.G. AGENCY INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered348
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,652
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 $11,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,731
Insurance broker organization code?3
Insurance broker nameM.M.G. AGENCY INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered379
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,762
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 $12,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,858
Insurance broker organization code?3
Insurance broker nameM.M.G. AGENCY INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered383
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,876
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 $13,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,938
Insurance broker organization code?3
Insurance broker nameM.M.G. AGENCY INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: )
Policy contract number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered383
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,644
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 $12,146
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 number6400-00-33
Policy instance 1
Insurance contract or identification number6400-00-33
Number of Individuals Covered390
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,644
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 $12,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,822
Insurance broker organization code?3
Insurance broker nameM.M.G. AGENCY INC.

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