401k Plan data: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN plan

XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 401k Plan overview

Plan Name	XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN
Plan identification number	503

XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN Benefits

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

401k Sponsoring company profile

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

Company Name: XLA

Employer identification number (EIN): 521653076

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-07-01 DEBORAH CEGIELSKI
503 2011-07-01 DEBORAH CEGIELSKI
503 2010-07-01 LLOYD M. MUSTIN II

Plan id#	Filing Submission Date	Name of Administrator
503	2012-07-01	DEBORAH CEGIELSKI
503	2011-07-01	DEBORAH CEGIELSKI
503	2010-07-01	LLOYD M. MUSTIN II

Plan Statistics for XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN

401k plan membership statisitcs for XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN

Measure Date Value
2012: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 155
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 0
Total of all active and inactive participants 2012-07-01 0
2011: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 189
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 155
Total of all active and inactive participants 2011-07-01 155
2010: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 118
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 189
Number of retired or separated participants receiving benefits 2010-07-01 0
Number of other retired or separated participants entitled to future benefits 2010-07-01 0
Total of all active and inactive participants 2010-07-01 189

Measure	Date	Value
2012: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	155
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	0
Total of all active and inactive participants	2012-07-01	0
2011: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	189
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	155
Total of all active and inactive participants	2011-07-01	155
2010: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	118
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	189
Number of retired or separated participants receiving benefits	2010-07-01	0
Number of other retired or separated participants entitled to future benefits	2010-07-01	0
Total of all active and inactive participants	2010-07-01	189

Form 5500 Responses for XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN

2012: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	This submission is the final filing	Yes
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: XL ASSOCIATES LIFE INSURANCE DISABILITY PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	First time form 5500 has been submitted	Yes
2010-07-01	Submission has been amended	No
2010-07-01	This submission is the final filing	No
2010-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-07-01	Plan is a collectively bargained plan	No
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5418507

Policy instance

Insurance contract or identification number	5418507
Number of Individuals Covered	156
Insurance policy start date	2012-07-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $2,074
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 $14,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,074
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5418507

Policy instance

Insurance contract or identification number	5418507
Number of Individuals Covered	155
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $3,811
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 $57,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5418507

Policy instance

Insurance contract or identification number	5418507
Number of Individuals Covered	184
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $12,113
Total amount of fees paid to insurance company	USD $6,886
Are there contracts with allocated funds for individual policies?	No
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $137,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	XLA
Employer identification number (EIN):	521653076
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services