401k Plan data: EMPLOYER PAID SHORT TERM DISABILITY INSURANCE plan

EMPLOYER PAID SHORT TERM DISABILITY INSURANCE 401k Plan overview

Plan Name	EMPLOYER PAID SHORT TERM DISABILITY INSURANCE
Plan identification number	509

EMPLOYER PAID SHORT TERM DISABILITY INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

ADVANCED BUSINESS MACHINES INC has sponsored the creation of one or more 401k plans.

Company Name: ADVANCED BUSINESS MACHINES INC

Employer identification number (EIN): 161226757

NAIC Classification: 423400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYER PAID SHORT TERM DISABILITY INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
509 2021-01-01
509 2021-01-01
509 2021-01-01 DAVID M. HILLERY 2023-07-13

Plan Statistics for EMPLOYER PAID SHORT TERM DISABILITY INSURANCE

401k plan membership statisitcs for EMPLOYER PAID SHORT TERM DISABILITY INSURANCE

Measure Date Value
2021: EMPLOYER PAID SHORT TERM DISABILITY INSURANCE 2021 401k membership
Total participants, beginning-of-year 2021-01-01 52
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 103
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 103
Total participants 2021-01-01 103
Number of employers contributing to the scheme 2021-01-01 6

Measure	Date	Value
2021: EMPLOYER PAID SHORT TERM DISABILITY INSURANCE 2021 401k membership
Total participants, beginning-of-year	2021-01-01	52
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	103
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	103
Total participants	2021-01-01	103
Number of employers contributing to the scheme	2021-01-01	6

Form 5500 Responses for EMPLOYER PAID SHORT TERM DISABILITY INSURANCE

2021: EMPLOYER PAID SHORT TERM DISABILITY INSURANCE 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	Yes
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

0421870

Policy instance

Insurance contract or identification number	0421870
Number of Individuals Covered	103
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,140
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,140

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

421870

Policy instance

Insurance contract or identification number	421870
Number of Individuals Covered	103
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,140
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,140
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

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Company Name:	ADVANCED BUSINESS MACHINES INC
Employer identification number (EIN):	161226757
NAIC Classification:	423400