401k Plan data: COLUMBIA IT, INC. LONG TERM DISABILITY plan

COLUMBIA IT, INC. LONG TERM DISABILITY 401k Plan overview

Plan Name	COLUMBIA IT, INC. LONG TERM DISABILITY
Plan identification number	505

COLUMBIA IT, INC. LONG TERM DISABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

COLUMBIA IT INC. has sponsored the creation of one or more 401k plans.

Company Name: COLUMBIA IT INC.

Employer identification number (EIN): 741609220

NAIC Classification: 531120
NAIC Description: Lessors of Nonresidential Buildings (except Miniwarehouses)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLUMBIA IT, INC. LONG TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2013-10-01 DAVID S HERRMAN
505 2012-10-01 DAVID HERRMANN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2013-10-01	DAVID S HERRMAN
505	2012-10-01	DAVID HERRMANN

Plan Statistics for COLUMBIA IT, INC. LONG TERM DISABILITY

401k plan membership statisitcs for COLUMBIA IT, INC. LONG TERM DISABILITY

Measure Date Value
2013: COLUMBIA IT, INC. LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year 2013-10-01 122
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 135
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 0
Total of all active and inactive participants 2013-10-01 135
2012: COLUMBIA IT, INC. LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year 2012-10-01 106
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 122
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 122

Measure	Date	Value
2013: COLUMBIA IT, INC. LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year	2013-10-01	122
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	135
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	0
Total of all active and inactive participants	2013-10-01	135
2012: COLUMBIA IT, INC. LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year	2012-10-01	106
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	122
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	122

Form 5500 Responses for COLUMBIA IT, INC. LONG TERM DISABILITY

2013: COLUMBIA IT, INC. LONG TERM DISABILITY 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: COLUMBIA IT, INC. LONG TERM DISABILITY 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05986761

Policy instance

Insurance contract or identification number	KM05986761
Number of Individuals Covered	319
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $1,468
Total amount of fees paid to insurance company	USD $134
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $14,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,534
Insurance broker organization code?	3
Amount paid for insurance broker fees	134
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker name	LAWRENCE MORRIS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05986761

Policy instance

Insurance contract or identification number	KM05986761
Number of Individuals Covered	287
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $2,240
Total amount of fees paid to insurance company	USD $142
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $11,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,417
Insurance broker organization code?	3
Amount paid for insurance broker fees	142
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

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Company Name:	COLUMBIA IT INC.
Employer identification number (EIN):	741609220
NAIC Classification:	531120
NAIC Description:	Lessors of Nonresidential Buildings (except Miniwarehouses)