401k Plan data: CUBRC TERM LIFE AND ADD plan

CUBRC TERM LIFE AND ADD 401k Plan overview

Plan Name	CUBRC TERM LIFE AND ADD
Plan identification number	521

CUBRC TERM LIFE AND ADD Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

CUBRC INC has sponsored the creation of one or more 401k plans.

Company Name: CUBRC INC

Employer identification number (EIN): 222505934

NAIC Classification: 541700

Additional information about CUBRC INC

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1983-12-07

Company Identification Number: 862775

Legal Registered Office Address: 4455 GENESEE STREET
SUITE 106
BUFFALO
United States of America (USA)
14225

More information about CUBRC INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUBRC TERM LIFE AND ADD

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
521 2020-01-01

Plan Statistics for CUBRC TERM LIFE AND ADD

401k plan membership statisitcs for CUBRC TERM LIFE AND ADD

Measure Date Value
2020: CUBRC TERM LIFE AND ADD 2020 401k membership
Total participants, beginning-of-year 2020-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 101
Total of all active and inactive participants 2020-01-01 101
Total participants 2020-01-01 101

Measure	Date	Value
2020: CUBRC TERM LIFE AND ADD 2020 401k membership
Total participants, beginning-of-year	2020-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	101
Total of all active and inactive participants	2020-01-01	101
Total participants	2020-01-01	101

Form 5500 Responses for CUBRC TERM LIFE AND ADD

2020: CUBRC TERM LIFE AND ADD 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000B99V

Policy instance

Insurance contract or identification number	G000B99V
Number of Individuals Covered	101
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,870
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $28,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,870
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000B99V

Policy instance

Insurance contract or identification number	G000B99V
Number of Individuals Covered	101
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $407
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $4,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $407
Insurance broker organization code?	3

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Company Name:	CUBRC INC
Employer identification number (EIN):	222505934
NAIC Classification:	541700

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1983-12-07
Company Identification Number:	862775
Legal Registered Office Address:	4455 GENESEE STREET SUITE 106 BUFFALO United States of America (USA) 14225