401k Plan data: HARTFORD LIFE AND ACCIDENT plan

HARTFORD LIFE AND ACCIDENT 401k Plan overview

Plan Name	HARTFORD LIFE AND ACCIDENT
Plan identification number	502

HARTFORD LIFE AND ACCIDENT Benefits

401k Plan Type	Welfare 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

ATTIC ANGEL ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name: ATTIC ANGEL ASSOCIATION

Employer identification number (EIN): 390854841

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HARTFORD LIFE AND ACCIDENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01 CHERYL MILLER
502 2016-01-01 CHERYL BEIERSDORFF
502 2013-01-01 CHERYL BEIERSDORFF
502 2012-01-01 CHERYL BEIERSDORFF
502 2011-01-01 CHERYL BEIERSDORFF

Plan id#	Filing Submission Date	Name of Administrator
502	2017-01-01	CHERYL MILLER
502	2016-01-01	CHERYL BEIERSDORFF
502	2013-01-01	CHERYL BEIERSDORFF
502	2012-01-01	CHERYL BEIERSDORFF
502	2011-01-01	CHERYL BEIERSDORFF

Plan Statistics for HARTFORD LIFE AND ACCIDENT

401k plan membership statisitcs for HARTFORD LIFE AND ACCIDENT

Measure Date Value
2017: HARTFORD LIFE AND ACCIDENT 2017 401k membership
Total participants, beginning-of-year 2017-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 201
Total of all active and inactive participants 2017-01-01 201
2016: HARTFORD LIFE AND ACCIDENT 2016 401k membership
Total participants, beginning-of-year 2016-01-01 178
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 194
Total of all active and inactive participants 2016-01-01 194
Total participants 2016-01-01 194
2013: HARTFORD LIFE AND ACCIDENT 2013 401k membership
Total participants, beginning-of-year 2013-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 159
Total of all active and inactive participants 2013-01-01 159
Total participants 2013-01-01 159
2012: HARTFORD LIFE AND ACCIDENT 2012 401k membership
Total participants, beginning-of-year 2012-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 161
Total of all active and inactive participants 2012-01-01 161
Total participants 2012-01-01 161
2011: HARTFORD LIFE AND ACCIDENT 2011 401k membership
Total participants, beginning-of-year 2011-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 162
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 162
Total participants 2011-01-01 162

Measure	Date	Value
2017: HARTFORD LIFE AND ACCIDENT 2017 401k membership
Total participants, beginning-of-year	2017-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	201
Total of all active and inactive participants	2017-01-01	201
2016: HARTFORD LIFE AND ACCIDENT 2016 401k membership
Total participants, beginning-of-year	2016-01-01	178
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	194
Total of all active and inactive participants	2016-01-01	194
Total participants	2016-01-01	194
2013: HARTFORD LIFE AND ACCIDENT 2013 401k membership
Total participants, beginning-of-year	2013-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	159
Total of all active and inactive participants	2013-01-01	159
Total participants	2013-01-01	159
2012: HARTFORD LIFE AND ACCIDENT 2012 401k membership
Total participants, beginning-of-year	2012-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	161
Total of all active and inactive participants	2012-01-01	161
Total participants	2012-01-01	161
2011: HARTFORD LIFE AND ACCIDENT 2011 401k membership
Total participants, beginning-of-year	2011-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	162
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	162
Total participants	2011-01-01	162

Form 5500 Responses for HARTFORD LIFE AND ACCIDENT

2017: HARTFORD LIFE AND ACCIDENT 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: HARTFORD LIFE AND ACCIDENT 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2013: HARTFORD LIFE AND ACCIDENT 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HARTFORD LIFE AND ACCIDENT 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HARTFORD LIFE AND ACCIDENT 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

876960G

Policy instance

Insurance contract or identification number	876960G
Number of Individuals Covered	201
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,195
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $57,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,195
Insurance broker organization code?	3
Insurance broker name	RICHARDS AGENCY INC

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Company Name:	ATTIC ANGEL ASSOCIATION
Employer identification number (EIN):	390854841
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities