401k Plan data: TOYS R US, INC. FLEXIBLE BENEFITS PLAN plan

TOYS R US, INC. FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	TOYS R US, INC. FLEXIBLE BENEFITS PLAN
Plan identification number	505

TOYS R US, INC. FLEXIBLE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

TOYS R US, INC. has sponsored the creation of one or more 401k plans.

Company Name: TOYS R US, INC.

Employer identification number (EIN): 223260693

NAIC Classification: 451120
NAIC Description: Hobby, Toy, and Game Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TOYS R US, INC. FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2017-07-01 ANTOINETTE DUAH
505 2017-07-01
505 2016-07-01 ANTOINETTE DUAH
505 2015-07-01 CHARLES D. KNIGHT
505 2014-07-01 JOHN GREGORY
505 2013-07-01 JOHN GREGORY
505 2012-07-01 JOHN GREGORY
505 2011-07-01 JOHN GREGORY
505 2010-07-01 JOHN GREGORY
505 2009-02-01 JOHN GREGORY

Plan Statistics for TOYS R US, INC. FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for TOYS R US, INC. FLEXIBLE BENEFITS PLAN

Measure Date Value
2017: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 32,297
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 0
Total of all active and inactive participants 2017-07-01 0
2016: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 25,882
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 32,297
Total of all active and inactive participants 2016-07-01 32,297
2015: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 25,724
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 25,882
Total of all active and inactive participants 2015-07-01 25,882
2014: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 25,775
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 25,724
Total of all active and inactive participants 2014-07-01 25,724
Total participants 2014-07-01 0
2013: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 29,039
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 25,775
Total of all active and inactive participants 2013-07-01 25,775
Total participants 2013-07-01 0
2012: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 28,365
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 29,039
Total of all active and inactive participants 2012-07-01 29,039
Total participants 2012-07-01 0
2011: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 28,975
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 28,365
Total of all active and inactive participants 2011-07-01 28,365
Total participants 2011-07-01 28,365
2010: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 27,988
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 28,975
Total of all active and inactive participants 2010-07-01 28,975
Total participants 2010-07-01 28,975
2009: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 28,673
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 29,444
Total of all active and inactive participants 2009-02-01 29,444
Total participants 2009-02-01 29,444

Measure	Date	Value
2017: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	32,297
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	0
Total of all active and inactive participants	2017-07-01	0
2016: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	25,882
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	32,297
Total of all active and inactive participants	2016-07-01	32,297
2015: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	25,724
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	25,882
Total of all active and inactive participants	2015-07-01	25,882
2014: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	25,775
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	25,724
Total of all active and inactive participants	2014-07-01	25,724
Total participants	2014-07-01	0
2013: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	29,039
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	25,775
Total of all active and inactive participants	2013-07-01	25,775
Total participants	2013-07-01	0
2012: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	28,365
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	29,039
Total of all active and inactive participants	2012-07-01	29,039
Total participants	2012-07-01	0
2011: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	28,975
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	28,365
Total of all active and inactive participants	2011-07-01	28,365
Total participants	2011-07-01	28,365
2010: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	27,988
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	28,975
Total of all active and inactive participants	2010-07-01	28,975
Total participants	2010-07-01	28,975
2009: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	28,673
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	29,444
Total of all active and inactive participants	2009-02-01	29,444
Total participants	2009-02-01	29,444

Form 5500 Responses for TOYS R US, INC. FLEXIBLE BENEFITS PLAN

2017: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	Yes
2017-07-01	This submission is the final filing	Yes
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	Yes
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: TOYS R US, INC. FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

802234

Policy instance

Insurance contract or identification number	802234
Number of Individuals Covered	0
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $68,775
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $569,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	0
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $197,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0721099-0866340

Policy instance

Insurance contract or identification number	0721099-0866340
Number of Individuals Covered	0
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $112,223
Total amount of fees paid to insurance company	USD $90,206
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,506,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	0
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $96,001
Vision Insurance Welfare Benefit	Yes
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 number

99080961

Policy instance

Insurance contract or identification number	99080961
Number of Individuals Covered	0
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $5,534
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $53,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	25882
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $250,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0721099-0866340

Policy instance

Insurance contract or identification number	0721099-0866340
Number of Individuals Covered	12236
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $87,471
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,777,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,471
Additional information about fees paid to insurance broker	WRITING AGENT/ADMIN & OTHER FEES
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC., 1 WORLD

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 9131769

Policy instance

Insurance contract or identification number	GTP 9131769
Number of Individuals Covered	25882
Insurance policy start date	2014-09-27
Insurance policy end date	2015-09-27
Total amount of commissions paid to insurance broker	USD $3,965
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $39,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,965
Additional information about fees paid to insurance broker	GENERAL AGENTS
Insurance broker organization code?	3
Insurance broker name	INTEGRO INSURANCE BROKERS

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	6163
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $120,812
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	120812
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	VISION SERVICE PLAN

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	6455
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of fees paid to insurance company	USD $133,080
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	133080
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	VISION SERVICE PLAN

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 9131769

Policy instance

Insurance contract or identification number	GTP 9131769
Number of Individuals Covered	25724
Insurance policy start date	2013-09-27
Insurance policy end date	2014-09-26
Total amount of commissions paid to insurance broker	USD $5,109
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $51,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,109
Additional information about fees paid to insurance broker	GENERAL AGENTS
Insurance broker organization code?	3
Insurance broker name	INTEGRO USA, INC.

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0721099-0866340

Policy instance

Insurance contract or identification number	0721099-0866340
Number of Individuals Covered	11421
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $93,571
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,882,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93,571
Additional information about fees paid to insurance broker	WRITING AGENT/ADMIN & OTHER FEES
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	25724
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $292,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	7105
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of fees paid to insurance company	USD $98,364
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	98364
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	VISION SERVICE PLAN

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	4489
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $36,446
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,702,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,446
Additional information about fees paid to insurance broker	WRITING AGENT/ADMIN & OTHER FEES
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	25775
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $322,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

ST-0100-1403

Policy instance

Insurance contract or identification number	ST-0100-1403
Number of Individuals Covered	1723
Insurance policy start date	2013-07-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251558

Policy instance

Insurance contract or identification number	DBL 251558
Number of Individuals Covered	11542
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $5,065
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $186,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,065
Additional information about fees paid to insurance broker	WRITING AGENT/ADMIN & OTHER FEES
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 9131769

Policy instance

Insurance contract or identification number	GTP 9131769
Number of Individuals Covered	25775
Insurance policy start date	2012-09-27
Insurance policy end date	2013-09-27
Total amount of commissions paid to insurance broker	USD $14,191
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $56,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,191
Additional information about fees paid to insurance broker	GENERAL AGENTS
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

43904

Policy instance

Insurance contract or identification number	43904
Number of Individuals Covered	21937
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $108,301
Total amount of fees paid to insurance company	USD $4,618
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,043,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $99,915
Additional information about fees paid to insurance broker	SALES AND SERVICE COMPENSATION
Insurance broker organization code?	3
Amount paid for insurance broker fees	4618
Insurance broker name	AXA ASSISTANCE, USA

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	4449
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $39,003
Total amount of fees paid to insurance company	USD $16,871
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,749,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,003
Amount paid for insurance broker fees	16871
Additional information about fees paid to insurance broker	WRITING AGENT/ADMIN & OTHER FEES
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 9131769

Policy instance

Insurance contract or identification number	GTP 9131769
Number of Individuals Covered	29039
Insurance policy start date	2011-09-27
Insurance policy end date	2012-09-27
Total amount of commissions paid to insurance broker	USD $14,191
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $56,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,191
Additional information about fees paid to insurance broker	GENERAL AGENTS
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	7413
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of fees paid to insurance company	USD $100,719
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	100719
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	VISION SERVICE PLAN

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251558

Policy instance

Insurance contract or identification number	DBL 251558
Number of Individuals Covered	11542
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $4,714
Total amount of fees paid to insurance company	USD $1,569
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $151,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,714
Amount paid for insurance broker fees	1569
Additional information about fees paid to insurance broker	WRITING AGENT/ADMIN & OTHER FEES
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

43904

Policy instance

Insurance contract or identification number	43904
Number of Individuals Covered	21832
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $117,445
Total amount of fees paid to insurance company	USD $4,687
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,984,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4687
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $19,888
Insurance broker name	WILLIS CORPORATION OF NEW YORK INC.

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	27058
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $309,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

ST-0100-1403

Policy instance

Insurance contract or identification number	ST-0100-1403
Number of Individuals Covered	1576
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	28365
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $327,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	7583
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of fees paid to insurance company	USD $107,897
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 9131769

Policy instance

Insurance contract or identification number	GTP 9131769
Number of Individuals Covered	28365
Insurance policy start date	2010-09-27
Insurance policy end date	2011-09-27
Total amount of commissions paid to insurance broker	USD $14,191
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $56,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251558

Policy instance

Insurance contract or identification number	DBL 251558
Number of Individuals Covered	13143
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $4,805
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $160,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	4417
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $66,325
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,684,201
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 number

43904

Policy instance

Insurance contract or identification number	43904
Number of Individuals Covered	40300
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $101,003
Total amount of fees paid to insurance company	USD $5,012
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,048,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

ST-0100-1403

Policy instance

Insurance contract or identification number	ST-0100-1403
Number of Individuals Covered	1919
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	7823
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of fees paid to insurance company	USD $109,496
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $995,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251558

Policy instance

Insurance contract or identification number	DBL 251558
Number of Individuals Covered	14331
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $4,881
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $168,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	29392
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $326,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	4612
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $67,450
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,714,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CHARTIS INSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

GTP 9112956

Policy instance

Insurance contract or identification number	GTP 9112956
Number of Individuals Covered	28975
Insurance policy start date	2010-06-30
Insurance policy end date	2010-09-27
Total amount of commissions paid to insurance broker	USD $2,969
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $14,847
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 number

43904

Policy instance

Insurance contract or identification number	43904
Number of Individuals Covered	41107
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $99,296
Total amount of fees paid to insurance company	USD $5,037
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,006,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

ST-0100-1403

Policy instance

Insurance contract or identification number	ST-0100-1403
Number of Individuals Covered	2482
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDICAL
Welfare Benefit Premiums Paid to Carrier	USD $2,719,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12206591

Policy instance

Insurance contract or identification number	12206591
Number of Individuals Covered	7823
Insurance policy start date	2010-02-01
Insurance policy end date	2010-06-30
Total amount of fees paid to insurance company	USD $42,217
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $422,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	42217
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	VISION SERVICE PLAN

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

ST-0100-1403

Policy instance

Insurance contract or identification number	ST-0100-1403
Number of Individuals Covered	2290
Insurance policy start date	2010-02-01
Insurance policy end date	2010-06-30
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDICAL
Welfare Benefit Premiums Paid to Carrier	USD $1,398,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	28779
Insurance policy start date	2010-02-01
Insurance policy end date	2010-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,875
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 number

43904

Policy instance

Insurance contract or identification number	43904
Number of Individuals Covered	44822
Insurance policy start date	2009-07-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $100,674
Total amount of fees paid to insurance company	USD $5,019
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,043,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $100,674
Additional information about fees paid to insurance broker	SALES & SERVICE COMPENSATION
Insurance broker organization code?	3
Amount paid for insurance broker fees	5019
Insurance broker name	AXA ASSISTANCE, USA

CHARTIS INSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

GTP 9112956

Policy instance

Insurance contract or identification number	GTP 9112956
Number of Individuals Covered	27988
Insurance policy start date	2009-09-27
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $9,209
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $46,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,209
Additional information about fees paid to insurance broker	GENERAL AGENTS
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	4546
Insurance policy start date	2010-02-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $20,874
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $529,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,874
Additional information about fees paid to insurance broker	WRITING AGENT
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 251558

Policy instance

Insurance contract or identification number	DBL 251558
Number of Individuals Covered	13036
Insurance policy start date	2010-02-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $1,657
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,657
Additional information about fees paid to insurance broker	WRITING AGENT
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK, INC.

Potentially related plans

TOYS R US EMPLOYEE BENEFIT PLAN [EIN = 832589704]

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Company Name:	TOYS R US, INC.
Employer identification number (EIN):	223260693
NAIC Classification:	451120
NAIC Description:	Hobby, Toy, and Game Stores

Plan id#	Filing Submission Date	Name of Administrator
505	2017-07-01	ANTOINETTE DUAH
505	2017-07-01
505	2016-07-01	ANTOINETTE DUAH
505	2015-07-01	CHARLES D. KNIGHT
505	2014-07-01	JOHN GREGORY
505	2013-07-01	JOHN GREGORY
505	2012-07-01	JOHN GREGORY
505	2011-07-01	JOHN GREGORY
505	2010-07-01	JOHN GREGORY
505	2009-02-01	JOHN GREGORY