401k Plan data: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN plan

GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 401k Plan overview

Plan Name	GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN
Plan identification number	508

GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

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

Company Name: GONZAGA UNIVERSITY

Employer identification number (EIN): 910236600

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2012-12-01 KIRK WOOD-GAINES
508 2012-12-01 KIRK WOOD-GAINES
508 2011-12-01 KIRK WOOD-GAINES
508 2010-12-01 MELBA BRUSKI
508 2009-12-01 CHARLES J. MURPHY

Plan id#	Filing Submission Date	Name of Administrator
508	2012-12-01	KIRK WOOD-GAINES
508	2012-12-01	KIRK WOOD-GAINES
508	2011-12-01	KIRK WOOD-GAINES
508	2010-12-01	MELBA BRUSKI
508	2009-12-01	CHARLES J. MURPHY

Plan Statistics for GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN

401k plan membership statisitcs for GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN

Measure Date Value
2012: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-12-01 130
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 138
Number of retired or separated participants receiving benefits 2012-12-01 0
Number of other retired or separated participants entitled to future benefits 2012-12-01 0
Total of all active and inactive participants 2012-12-01 138
2011: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-12-01 146
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 130
Number of retired or separated participants receiving benefits 2011-12-01 0
Number of other retired or separated participants entitled to future benefits 2011-12-01 0
Total of all active and inactive participants 2011-12-01 130
2010: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-12-01 182
Total number of active participants reported on line 7a of the Form 5500 2010-12-01 169
Number of retired or separated participants receiving benefits 2010-12-01 0
Number of other retired or separated participants entitled to future benefits 2010-12-01 0
Total of all active and inactive participants 2010-12-01 169
2009: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-12-01 136
Total number of active participants reported on line 7a of the Form 5500 2009-12-01 182
Number of retired or separated participants receiving benefits 2009-12-01 0
Number of other retired or separated participants entitled to future benefits 2009-12-01 0
Total of all active and inactive participants 2009-12-01 182

Measure	Date	Value
2012: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-12-01	130
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	138
Number of retired or separated participants receiving benefits	2012-12-01	0
Number of other retired or separated participants entitled to future benefits	2012-12-01	0
Total of all active and inactive participants	2012-12-01	138
2011: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-12-01	146
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	130
Number of retired or separated participants receiving benefits	2011-12-01	0
Number of other retired or separated participants entitled to future benefits	2011-12-01	0
Total of all active and inactive participants	2011-12-01	130
2010: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-12-01	182
Total number of active participants reported on line 7a of the Form 5500	2010-12-01	169
Number of retired or separated participants receiving benefits	2010-12-01	0
Number of other retired or separated participants entitled to future benefits	2010-12-01	0
Total of all active and inactive participants	2010-12-01	169
2009: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-12-01	136
Total number of active participants reported on line 7a of the Form 5500	2009-12-01	182
Number of retired or separated participants receiving benefits	2009-12-01	0
Number of other retired or separated participants entitled to future benefits	2009-12-01	0
Total of all active and inactive participants	2009-12-01	182

Form 5500 Responses for GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN

2012: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Submission has been amended	No
2012-12-01	This submission is the final filing	No
2012-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-12-01	Plan is a collectively bargained plan	No
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2011: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	Submission has been amended	No
2011-12-01	This submission is the final filing	No
2011-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-12-01	Plan is a collectively bargained plan	No
2011-12-01	Plan funding arrangement – Insurance	Yes
2011-12-01	Plan benefit arrangement – Insurance	Yes
2010: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2010 form 5500 responses
2010-12-01	Type of plan entity	Single employer plan
2010-12-01	Submission has been amended	No
2010-12-01	This submission is the final filing	No
2010-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-12-01	Plan is a collectively bargained plan	No
2010-12-01	Plan funding arrangement – Insurance	Yes
2010-12-01	Plan benefit arrangement – Insurance	Yes
2009: GONZAGA UNIVERSITY SUPPLEMENTAL LONG TERM DISABILITY PLAN 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	Submission has been amended	No
2009-12-01	This submission is the final filing	No
2009-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-12-01	Plan is a collectively bargained plan	No
2009-12-01	Plan funding arrangement – Insurance	Yes
2009-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MASS MUTUAL (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8372463

Policy instance

Insurance contract or identification number	8372463
Number of Individuals Covered	138
Insurance policy start date	2012-12-01
Insurance policy end date	2013-11-30
Total amount of commissions paid to insurance broker	USD $4,209
Total amount of fees paid to insurance company	USD $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 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 $61,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,223
Insurance broker organization code?	3
Insurance broker name	SARAH L. CARLSON RIEGER

MASS MUTUAL (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8372463

Policy instance

Insurance contract or identification number	8372463
Number of Individuals Covered	130
Insurance policy start date	2011-12-01
Insurance policy end date	2012-11-30
Total amount of commissions paid to insurance broker	USD $4,576
Total amount of fees paid to insurance company	USD $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 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 $69,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASS MUTUAL (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8372463

Policy instance

Insurance contract or identification number	8372463
Number of Individuals Covered	169
Insurance policy start date	2010-12-01
Insurance policy end date	2011-11-30
Total amount of commissions paid to insurance broker	USD $6,090
Total amount of fees paid to insurance company	USD $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 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 $76,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GONZAGA UNIVERSITY
Employer identification number (EIN):	910236600
NAIC Classification:	611000