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HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN 401k Plan overview

Plan NameHUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN
Plan identification number 502

HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Long-term disability cover

401k Sponsoring company profile

HUMANE SOCIETY OF TAMPA BAY has sponsored the creation of one or more 401k plans.

Company Name:HUMANE SOCIETY OF TAMPA BAY
Employer identification number (EIN):590799907
NAIC Classification:812910
NAIC Description:Pet Care (except Veterinary) Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022017-01-01PAM DUVAL

Plan Statistics for HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN

401k plan membership statisitcs for HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN

Measure Date Value
2017: HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0195
Total number of active participants reported on line 7a of the Form 55002017-01-0195
Number of retired or separated participants receiving benefits2017-01-010
Total of all active and inactive participants2017-01-0195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0195

Form 5500 Responses for HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN

2017: HUMANE SOCIETY OF TAMPA BAY ANCILLARY BENEFITS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL138781
Policy instance 1
Insurance contract or identification numberGL138781
Number of Individuals Covered95
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $2,805
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD112709
Policy instance 2
Insurance contract or identification numberLTD112709
Number of Individuals Covered95
Insurance policy start date2017-05-02
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $1,716
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $1,716
Insurance broker organization code?3
Insurance broker nameJOHNNY R ADCOCK CLU & ASSOCIATES

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