401k Plan data: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. plan

SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 401k Plan overview

Plan Name	SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC.
Plan identification number	507

SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

CHANDLER USA INC has sponsored the creation of one or more 401k plans.

Company Name: CHANDLER USA INC

Employer identification number (EIN): 731325906

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2017-01-01 HOGANTAYLOR LLP PREPARER
507 2016-01-01 HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER 2017-07-26
507 2015-01-01 HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER 2016-07-28
507 2014-01-01 HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER 2015-07-29
507 2013-01-01 HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER 2014-07-31
507 2012-01-01 HOGANTAYLOR LLP PREPARER
507 2011-01-01 HOGANTAYLOR LLP PREPARER
507 2009-01-01 HOGAN TAYLOR LLP

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
507	2017-01-01	HOGANTAYLOR LLP PREPARER
507	2016-01-01	HOGANTAYLOR LLP PREPARER	HOGANTAYLOR LLP PREPARER	2017-07-26
507	2015-01-01	HOGANTAYLOR LLP PREPARER	HOGANTAYLOR LLP PREPARER	2016-07-28
507	2014-01-01	HOGANTAYLOR LLP PREPARER	HOGANTAYLOR LLP PREPARER	2015-07-29
507	2013-01-01	HOGANTAYLOR LLP PREPARER	HOGANTAYLOR LLP PREPARER	2014-07-31
507	2012-01-01	HOGANTAYLOR LLP PREPARER
507	2011-01-01	HOGANTAYLOR LLP PREPARER
507	2009-01-01	HOGAN TAYLOR LLP

Plan Statistics for SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC.

401k plan membership statisitcs for SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC.

Measure Date Value
2017: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3
Total of all active and inactive participants 2017-01-01 3
Total participants 2017-01-01 3
2016: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 5
Total of all active and inactive participants 2016-01-01 5
Total participants 2016-01-01 5
2015: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 5
Total of all active and inactive participants 2015-01-01 5
Total participants 2015-01-01 5
2014: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 5
Total of all active and inactive participants 2014-01-01 5
Total participants 2014-01-01 5
2013: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5
Total of all active and inactive participants 2013-01-01 5
Total participants 2013-01-01 5
2012: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 5
Total of all active and inactive participants 2012-01-01 5
Total participants 2012-01-01 5
2011: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 5
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 5
Total participants 2011-01-01 5
2009: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 5
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 5
Total participants 2009-01-01 5

Measure	Date	Value
2017: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3
Total of all active and inactive participants	2017-01-01	3
Total participants	2017-01-01	3
2016: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	5
Total of all active and inactive participants	2016-01-01	5
Total participants	2016-01-01	5
2015: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	5
Total of all active and inactive participants	2015-01-01	5
Total participants	2015-01-01	5
2014: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5
Total of all active and inactive participants	2014-01-01	5
Total participants	2014-01-01	5
2013: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5
Total of all active and inactive participants	2013-01-01	5
Total participants	2013-01-01	5
2012: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	5
Total of all active and inactive participants	2012-01-01	5
Total participants	2012-01-01	5
2011: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	5
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	5
Total participants	2011-01-01	5
2009: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	5
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	5
Total participants	2009-01-01	5

Form 5500 Responses for SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC.

2017: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: SPLIT DOLLAR INSURANCE PLAN OF CHANDLER (U.S.A.), INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

U01464611

Policy instance

Insurance contract or identification number	U01464611
Number of Individuals Covered	3
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $10,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

SPLIT DOLLAR LIFE INSURANCE PLAN [EIN = 061026471]

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Company Name:	CHANDLER USA INC
Employer identification number (EIN):	731325906
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages