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CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 401k Plan overview

Plan NameCHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN
Plan identification number 001

CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. has sponsored the creation of one or more 401k plans.

Company Name:CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC.
Employer identification number (EIN):620526054
NAIC Classification:561490

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01RAE YOUNG BOND2023-10-16
0012021-01-01IRA WEISS2022-08-01
0012020-01-01RAE YOUNG BOND2021-10-04 RAE YOUNG BOND2021-10-04
0012019-01-01JENNIFER BROOMFIELD2020-06-11 JENNIFER BROOMFIELD2020-06-11
0012018-01-01JENNIFER BROOMFIELD2019-07-03 JENNIFER BROOMFIELD2019-07-03
0012017-01-01RAE YOUNG BOND2018-06-20 RAE YOUNG BOND2018-06-20
0012016-01-01RAE YOUNG BOND2017-07-13 RAE YOUNG BOND2017-07-13
0012015-01-01RAE YOUNG BOND2016-07-08 RAE YOUNG BOND2016-07-08
0012014-01-01RAE YOUNG BOND RAE YOUNG BOND2015-07-06
0012013-01-01RAE BOND RAE BOND2014-06-23
0012012-01-01RAE BOND RAE BOND2013-07-12
0012011-01-01RAE BOND
0012009-01-01RAE BOND RAE BOND2010-08-02
0012009-01-012010-07-30

Plan Statistics for CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN

401k plan membership statisitcs for CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN

Measure Date Value
2014: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-019
Total number of active participants reported on line 7a of the Form 55002014-01-019
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-019
Number of participants with account balances2014-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-017
Total number of active participants reported on line 7a of the Form 55002013-01-0111
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0111
Number of participants with account balances2013-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-012
2012: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0111
Total number of active participants reported on line 7a of the Form 55002012-01-017
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0110
Number of participants with account balances2012-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-011
2011: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0110
Total number of active participants reported on line 7a of the Form 55002011-01-019
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-019
Number of participants with account balances2011-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-018
Total number of active participants reported on line 7a of the Form 55002009-01-018
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-012
Total of all active and inactive participants2009-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0110
Number of participants with account balances2009-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011

Financial Data on CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN

Measure Date Value
2014 : CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total income from all sources2014-12-31$98,954
Expenses. Total of all expenses incurred2014-12-31$90,312
Benefits paid (including direct rollovers)2014-12-31$90,312
Total plan assets at end of year2014-12-31$430,326
Total plan assets at beginning of year2014-12-31$421,684
Value of fidelity bond covering the plan2014-12-31$125,000
Total contributions received or receivable from participants2014-12-31$53,623
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$19,201
Other income received2014-12-31$13,991
Net income (gross income less expenses)2014-12-31$8,642
Net plan assets at end of year (total assets less liabilities)2014-12-31$430,326
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$421,684
Assets. Value of participant loans2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$12,139
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$0
Amount contributed by the employer to the plan for this plan year2014-12-31$0
2013 : CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$87,350
Expenses. Total of all expenses incurred2013-12-31$40,824
Benefits paid (including direct rollovers)2013-12-31$40,824
Total plan assets at end of year2013-12-31$421,684
Total plan assets at beginning of year2013-12-31$375,158
Value of fidelity bond covering the plan2013-12-31$125,000
Total contributions received or receivable from participants2013-12-31$26,999
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$52,292
Net income (gross income less expenses)2013-12-31$46,526
Net plan assets at end of year (total assets less liabilities)2013-12-31$421,684
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$375,158
Assets. Value of participant loans2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$8,059
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Funding deficiency by the employer to the plan for this plan year2013-12-31$0
Minimum employer required contribution for this plan year2013-12-31$0
Amount contributed by the employer to the plan for this plan year2013-12-31$0
2012 : CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$76,106
Expenses. Total of all expenses incurred2012-12-31$21,441
Benefits paid (including direct rollovers)2012-12-31$21,375
Total plan assets at end of year2012-12-31$375,158
Total plan assets at beginning of year2012-12-31$320,493
Value of fidelity bond covering the plan2012-12-31$125,000
Total contributions received or receivable from participants2012-12-31$29,091
Expenses. Other expenses not covered elsewhere2012-12-31$66
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$37,090
Net income (gross income less expenses)2012-12-31$54,665
Net plan assets at end of year (total assets less liabilities)2012-12-31$375,158
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$320,493
Assets. Value of participant loans2012-12-31$1,380
Total contributions received or receivable from employer(s)2012-12-31$9,925
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
2011 : CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$33,276
Expenses. Total of all expenses incurred2011-12-31$474
Benefits paid (including direct rollovers)2011-12-31$474
Total plan assets at end of year2011-12-31$320,493
Total plan assets at beginning of year2011-12-31$287,691
Value of fidelity bond covering the plan2011-12-31$125,000
Total contributions received or receivable from participants2011-12-31$34,543
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-13,236
Net income (gross income less expenses)2011-12-31$32,802
Net plan assets at end of year (total assets less liabilities)2011-12-31$320,493
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$287,691
Assets. Value of participant loans2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$11,969
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Funding deficiency by the employer to the plan for this plan year2011-12-31$0
Minimum employer required contribution for this plan year2011-12-31$0
Amount contributed by the employer to the plan for this plan year2011-12-31$0
2010 : CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$71,294
Expenses. Total of all expenses incurred2010-12-31$541
Benefits paid (including direct rollovers)2010-12-31$541
Total plan assets at end of year2010-12-31$287,691
Total plan assets at beginning of year2010-12-31$216,938
Value of fidelity bond covering the plan2010-12-31$125,000
Total contributions received or receivable from participants2010-12-31$34,553
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$24,442
Net income (gross income less expenses)2010-12-31$70,753
Net plan assets at end of year (total assets less liabilities)2010-12-31$287,691
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$216,938
Assets. Value of participant loans2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$12,299
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$0
Amount contributed by the employer to the plan for this plan year2010-12-31$0
2009 : CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$0
Amount contributed by the employer to the plan for this plan year2009-12-31$0

Form 5500 Responses for CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN

2014: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: CHATTANOOGA AND HAMILTON COUNTY MEDICAL SOCIETY, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-829596
Policy instance 1
Insurance contract or identification numberGA-829596
Number of Individuals Covered5
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809126
Policy instance 1
Insurance contract or identification numberGA-809126
Number of Individuals Covered5
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,966
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,966
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SVCS INS AGCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809126
Policy instance 1
Insurance contract or identification numberGA-809126
Number of Individuals Covered5
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,706
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,706
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SVCS INS AGCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809126
Policy instance 1
Insurance contract or identification numberGA-809126
Number of Individuals Covered6
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,528
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809126
Policy instance 1
Insurance contract or identification numberGA-809126
Number of Individuals Covered6
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,172
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,172
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SVCS INS AGCY

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