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GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 401k Plan overview

Plan NameGOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN
Plan identification number 501

GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

GOLDBERG SEGALLA LLP has sponsored the creation of one or more 401k plans.

Company Name:GOLDBERG SEGALLA LLP
Employer identification number (EIN):161603155
NAIC Classification:541110
NAIC Description:Offices of Lawyers

Additional information about GOLDBERG SEGALLA LLP

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 2001-03-30
Company Identification Number: 2622893
Legal Registered Office Address: 665 MAIN STREET
SUITE 400
BUFFALO
United States of America (USA)
14203

More information about GOLDBERG SEGALLA LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012014-01-01HEATHER A. MARCIANO
5012013-01-01HEATHER A. PUDLEWSKI
5012012-01-01HEATHER A. PUDLEWSKI
5012011-01-01HEATHER A. PUDLEWSKI
5012009-01-01HEATHER A. PUDLEWSKI

Plan Statistics for GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN

401k plan membership statisitcs for GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN

Measure Date Value
2014: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01311
Total number of active participants reported on line 7a of the Form 55002014-01-010
Total of all active and inactive participants2014-01-010
2013: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01277
Total number of active participants reported on line 7a of the Form 55002013-01-01311
Total of all active and inactive participants2013-01-01311
2012: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01232
Total number of active participants reported on line 7a of the Form 55002012-01-01276
Total of all active and inactive participants2012-01-01276
2011: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01196
Total number of active participants reported on line 7a of the Form 55002011-01-01210
Total of all active and inactive participants2011-01-01210
2009: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01171
Total number of active participants reported on line 7a of the Form 55002009-01-01195
Total of all active and inactive participants2009-01-01195

Form 5500 Responses for GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN

2014: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01This submission is the final filingYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: GOLDBERG SEGALLA LIFE, AD&D, ST DBL & LT DBL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number11595
Policy instance 1
Insurance contract or identification number11595
Number of Individuals Covered384
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $14,904
Total amount of fees paid to insurance companyUSD $116
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $273,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,904
Insurance broker organization code?3
Amount paid for insurance broker fees116
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number11595
Policy instance 2
Insurance contract or identification number11595
Number of Individuals Covered76
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number11595
Policy instance 1
Insurance contract or identification number11595
Number of Individuals Covered331
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $13,126
Total amount of fees paid to insurance companyUSD $101
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $208,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,126
Insurance broker organization code?3
Amount paid for insurance broker fees101
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number11595
Policy instance 2
Insurance contract or identification number11595
Number of Individuals Covered76
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number11595
Policy instance 1
Insurance contract or identification number11595
Number of Individuals Covered256
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $12,356
Total amount of fees paid to insurance companyUSD $76
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $183,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,356
Insurance broker organization code?3
Amount paid for insurance broker fees76
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number11595
Policy instance 2
Insurance contract or identification number11595
Number of Individuals Covered69
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $30,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number904922
Policy instance 3
Insurance contract or identification number904922
Number of Individuals Covered21
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $716
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463682
Policy instance 2
Insurance contract or identification number463682
Number of Individuals Covered183
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,960
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463683
Policy instance 1
Insurance contract or identification number463683
Number of Individuals Covered210
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $11,331
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $179,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number906026
Policy instance 4
Insurance contract or identification number906026
Number of Individuals Covered36
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,135
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number906026
Policy instance 4
Insurance contract or identification number906026
Number of Individuals Covered36
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,417
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,417
Insurance broker organization code?3
Insurance broker nameROBERT B. COHEN
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number904922
Policy instance 3
Insurance contract or identification number904922
Number of Individuals Covered21
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,135
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,135
Insurance broker organization code?3
Insurance broker nameROBERT B. COHEN
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463683
Policy instance 1
Insurance contract or identification number463683
Number of Individuals Covered196
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $14,181
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $262,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,181
Insurance broker organization code?3
Insurance broker nameROBERT B. COHEN
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463682
Policy instance 2
Insurance contract or identification number463682
Number of Individuals Covered183
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,057
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,057
Insurance broker organization code?3
Insurance broker nameROBERT B. COHEN

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