401k Plan data: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT plan

SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 401k Plan overview

Plan Name	SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT
Plan identification number	503

SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: SAMFORD UNIVERSITY

Employer identification number (EIN): 630312914

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-06-01 JOEL WINDHAM
503 2017-06-01
503 2016-06-01 JOEL WINDHAM
503 2015-06-01 JOEL WINDHAM
503 2014-06-01 JOEL WINDHAM
503 2013-06-01 CHARLES ROGAN CHARLES ROGAN 2015-08-07
503 2012-06-01 CHARLES ROGAN CHARLES ROGAN 2014-05-19
503 2011-06-01 CHARLES ROGAN CHARLES ROGAN 2013-07-24
503 2009-06-01 CHARLES ROGAN

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2017-06-01	JOEL WINDHAM
503	2017-06-01
503	2016-06-01	JOEL WINDHAM
503	2015-06-01	JOEL WINDHAM
503	2014-06-01	JOEL WINDHAM
503	2013-06-01	CHARLES ROGAN	CHARLES ROGAN	2015-08-07
503	2012-06-01	CHARLES ROGAN	CHARLES ROGAN	2014-05-19
503	2011-06-01	CHARLES ROGAN	CHARLES ROGAN	2013-07-24
503	2009-06-01	CHARLES ROGAN

Plan Statistics for SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT

401k plan membership statisitcs for SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT

Measure Date Value
2017: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year 2017-06-01 978
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 984
Total of all active and inactive participants 2017-06-01 984
Total participants 2017-06-01 984
2016: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year 2016-06-01 965
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 966
Total of all active and inactive participants 2016-06-01 966
Total participants 2016-06-01 966
2015: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year 2015-06-01 926
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 965
Total of all active and inactive participants 2015-06-01 965
Total participants 2015-06-01 965
2014: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year 2014-06-01 892
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 926
Total of all active and inactive participants 2014-06-01 926
Total participants 2014-06-01 926
2013: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year 2013-06-01 91
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 89
Total of all active and inactive participants 2013-06-01 89
Total participants 2013-06-01 89
2012: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year 2012-06-01 929
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 918
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 918
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-06-01 0
Total participants 2012-06-01 918
2011: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year 2011-06-01 837
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 926
Number of retired or separated participants receiving benefits 2011-06-01 0
Number of other retired or separated participants entitled to future benefits 2011-06-01 0
Total of all active and inactive participants 2011-06-01 926
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-06-01 0
Total participants 2011-06-01 926
2009: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year 2009-06-01 837
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 881
Number of retired or separated participants receiving benefits 2009-06-01 0
Number of other retired or separated participants entitled to future benefits 2009-06-01 0
Total of all active and inactive participants 2009-06-01 881
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-06-01 0
Total participants 2009-06-01 881

Measure	Date	Value
2017: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year	2017-06-01	978
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	984
Total of all active and inactive participants	2017-06-01	984
Total participants	2017-06-01	984
2016: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year	2016-06-01	965
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	966
Total of all active and inactive participants	2016-06-01	966
Total participants	2016-06-01	966
2015: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year	2015-06-01	926
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	965
Total of all active and inactive participants	2015-06-01	965
Total participants	2015-06-01	965
2014: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year	2014-06-01	892
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	926
Total of all active and inactive participants	2014-06-01	926
Total participants	2014-06-01	926
2013: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year	2013-06-01	91
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	89
Total of all active and inactive participants	2013-06-01	89
Total participants	2013-06-01	89
2012: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year	2012-06-01	929
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	918
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	918
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-06-01	0
Total participants	2012-06-01	918
2011: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year	2011-06-01	837
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	926
Number of retired or separated participants receiving benefits	2011-06-01	0
Number of other retired or separated participants entitled to future benefits	2011-06-01	0
Total of all active and inactive participants	2011-06-01	926
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-06-01	0
Total participants	2011-06-01	926
2009: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year	2009-06-01	837
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	881
Number of retired or separated participants receiving benefits	2009-06-01	0
Number of other retired or separated participants entitled to future benefits	2009-06-01	0
Total of all active and inactive participants	2009-06-01	881
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-06-01	0
Total participants	2009-06-01	881

Form 5500 Responses for SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT

2017: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Submission has been amended	No
2017-06-01	This submission is the final filing	No
2017-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-06-01	Plan is a collectively bargained plan	No
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2016: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Submission has been amended	No
2016-06-01	This submission is the final filing	No
2016-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-06-01	Plan is a collectively bargained plan	No
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2015: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Submission has been amended	No
2015-06-01	This submission is the final filing	No
2015-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-06-01	Plan is a collectively bargained plan	No
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2014: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	No
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	First time form 5500 has been submitted	Yes
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	First time form 5500 has been submitted	Yes
2012-06-01	Submission has been amended	No
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	First time form 5500 has been submitted	Yes
2011-06-01	Submission has been amended	No
2011-06-01	This submission is the final filing	No
2011-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-06-01	Plan is a collectively bargained plan	No
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2009: SAMFORD UNIVERSITY GROUP ACCIDENTAL DEATH AND DISMEMBERMENT 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	First time form 5500 has been submitted	Yes
2009-06-01	Submission has been amended	No
2009-06-01	This submission is the final filing	No
2009-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-06-01	Plan is a collectively bargained plan	No
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061269

Policy instance

Insurance contract or identification number	000099061269
Number of Individuals Covered	984
Insurance policy start date	2017-06-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,242
Total amount of fees paid to insurance company	USD $0
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 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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $21,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,242
Insurance broker name	ABLE BENEFIT SOLUTIONS

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Company Name:	SAMFORD UNIVERSITY
Employer identification number (EIN):	630312914
NAIC Classification:	611000