401k Plan data: GROUP LIFE/AD&D/STD/LTD PLAN plan

GROUP LIFE/AD&D/STD/LTD PLAN 401k Plan overview

Plan Name	GROUP LIFE/AD&D/STD/LTD PLAN
Plan identification number	504

GROUP LIFE/AD&D/STD/LTD PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

COLUMBIA COUNTRY CLUB has sponsored the creation of one or more 401k plans.

Company Name: COLUMBIA COUNTRY CLUB

Employer identification number (EIN): 520278100

NAIC Classification: 713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP LIFE/AD&D/STD/LTD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2023-10-01 ADRIANNA SERRANO
504 2022-10-01
504 2022-10-01 ADRIANNA SERRANO
504 2021-10-01
504 2021-10-01 STEVE O'GRADY
504 2020-10-01
504 2019-10-01
504 2016-10-01 DEBRAH ALY DEBRAH ALY 2018-03-14
504 2015-10-01 WILLIAM DUTHE WILLIAM DUTHE 2017-04-14
504 2014-10-01 WILLIAM DUTHE WILLIAM DUTHE 2016-04-29
504 2013-10-01 WILLIAM DUTHE WILLIAM DUTHE 2015-04-30
504 2012-10-01 WILLIAM DUTHE WILLIAM DUTHE 2014-04-07
504 2011-10-01 JAMES TROPPMAN JAMES TROPPMAN 2013-04-26
504 2009-10-01 JAMES TROPPMAN JAMES TROPPMAN 2011-04-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2023-10-01	ADRIANNA SERRANO
504	2022-10-01
504	2022-10-01	ADRIANNA SERRANO
504	2021-10-01
504	2021-10-01	STEVE O'GRADY
504	2020-10-01
504	2019-10-01
504	2016-10-01	DEBRAH ALY	DEBRAH ALY	2018-03-14
504	2015-10-01	WILLIAM DUTHE	WILLIAM DUTHE	2017-04-14
504	2014-10-01	WILLIAM DUTHE	WILLIAM DUTHE	2016-04-29
504	2013-10-01	WILLIAM DUTHE	WILLIAM DUTHE	2015-04-30
504	2012-10-01	WILLIAM DUTHE	WILLIAM DUTHE	2014-04-07
504	2011-10-01	JAMES TROPPMAN	JAMES TROPPMAN	2013-04-26
504	2009-10-01	JAMES TROPPMAN	JAMES TROPPMAN	2011-04-15

Plan Statistics for GROUP LIFE/AD&D/STD/LTD PLAN

401k plan membership statisitcs for GROUP LIFE/AD&D/STD/LTD PLAN

Measure Date Value
2022: GROUP LIFE/AD&D/STD/LTD PLAN 2022 401k membership
Total participants, beginning-of-year 2022-10-01 152
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 173
Number of retired or separated participants receiving benefits 2022-10-01 0
Number of other retired or separated participants entitled to future benefits 2022-10-01 0
Total of all active and inactive participants 2022-10-01 173
2021: GROUP LIFE/AD&D/STD/LTD PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 141
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 152
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 152
2020: GROUP LIFE/AD&D/STD/LTD PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 168
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 141
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 141
2019: GROUP LIFE/AD&D/STD/LTD PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 153
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 168
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 168
2016: GROUP LIFE/AD&D/STD/LTD PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 132
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 147
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 147
2015: GROUP LIFE/AD&D/STD/LTD PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 132
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 132
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 132
2014: GROUP LIFE/AD&D/STD/LTD PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 126
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 132
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 132
2013: GROUP LIFE/AD&D/STD/LTD PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 138
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 126
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 0
Total of all active and inactive participants 2013-10-01 126
2012: GROUP LIFE/AD&D/STD/LTD PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 131
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 138
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 138
2011: GROUP LIFE/AD&D/STD/LTD PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 133
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 131
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 0
Total of all active and inactive participants 2011-10-01 131
2009: GROUP LIFE/AD&D/STD/LTD PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 125
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 140
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 0
Total of all active and inactive participants 2009-10-01 140

Measure	Date	Value
2022: GROUP LIFE/AD&D/STD/LTD PLAN 2022 401k membership
Total participants, beginning-of-year	2022-10-01	152
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	173
Number of retired or separated participants receiving benefits	2022-10-01	0
Number of other retired or separated participants entitled to future benefits	2022-10-01	0
Total of all active and inactive participants	2022-10-01	173
2021: GROUP LIFE/AD&D/STD/LTD PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	141
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	152
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	152
2020: GROUP LIFE/AD&D/STD/LTD PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	168
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	141
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	141
2019: GROUP LIFE/AD&D/STD/LTD PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	153
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	168
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	168
2016: GROUP LIFE/AD&D/STD/LTD PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	132
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	147
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	147
2015: GROUP LIFE/AD&D/STD/LTD PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	132
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	132
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	132
2014: GROUP LIFE/AD&D/STD/LTD PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	126
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	132
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	132
2013: GROUP LIFE/AD&D/STD/LTD PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	138
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	126
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	0
Total of all active and inactive participants	2013-10-01	126
2012: GROUP LIFE/AD&D/STD/LTD PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	131
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	138
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	138
2011: GROUP LIFE/AD&D/STD/LTD PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	133
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	131
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	0
Total of all active and inactive participants	2011-10-01	131
2009: GROUP LIFE/AD&D/STD/LTD PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	125
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	140
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	0
Total of all active and inactive participants	2009-10-01	140

Form 5500 Responses for GROUP LIFE/AD&D/STD/LTD PLAN

2022: GROUP LIFE/AD&D/STD/LTD PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2021: GROUP LIFE/AD&D/STD/LTD PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2020: GROUP LIFE/AD&D/STD/LTD PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2019: GROUP LIFE/AD&D/STD/LTD PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2016: GROUP LIFE/AD&D/STD/LTD PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: GROUP LIFE/AD&D/STD/LTD PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: GROUP LIFE/AD&D/STD/LTD PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: GROUP LIFE/AD&D/STD/LTD PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: GROUP LIFE/AD&D/STD/LTD PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2011: GROUP LIFE/AD&D/STD/LTD PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2009: GROUP LIFE/AD&D/STD/LTD PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUGBL9B
Policy instance	3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0BL9B
Policy instance	2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0BL9B
Policy instance	1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUGBL9B
Policy instance	3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0BL9B
Policy instance	2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0BL9B
Policy instance	1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUGBL9B
Policy instance	3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0BL9B
Policy instance	2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0BL9B
Policy instance	1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GUGBL9B
Policy instance	3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0BL9B
Policy instance	2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0BL9B
Policy instance	1
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	0686265
Policy instance	1
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	0686265
Policy instance	1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	224979
Policy instance	1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	224979
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	54830
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	54830
Policy instance	1

Potentially related plans

GROUP LIFE/AD&D/STD/LTD PLAN [EIN = 262620786]

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Company Name:	COLUMBIA COUNTRY CLUB
Employer identification number (EIN):	520278100
NAIC Classification:	713900