401k Plan data: UNUM 224167 plan

UNUM 224167 401k Plan overview

Plan Name	UNUM 224167
Plan identification number	507

UNUM 224167 Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Life insurance
Temporary disability (accident and sickness)
Death benefits (include travel accident but not life insurance)
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
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

THE ROGOSIN INSTITUTE has sponsored the creation of one or more 401k plans.

Company Name: THE ROGOSIN INSTITUTE

Employer identification number (EIN): 133184198

NAIC Classification: 621492
NAIC Description: Kidney Dialysis Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNUM 224167

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2017-01-01 DIANA DECOLONGON 2020-11-09
507 2016-01-01 DIANA DECOLONGON 2020-11-09
507 2013-01-01 KATHLEEN CASTILLO
507 2013-01-01 DIANA DECOLONGON 2020-11-09
507 2012-01-01 KATHLEEN CASTILLO
507 2011-01-01 KATHLEEN CASTILLO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
507	2017-01-01	DIANA DECOLONGON	2020-11-09
507	2016-01-01	DIANA DECOLONGON	2020-11-09
507	2013-01-01	KATHLEEN CASTILLO
507	2013-01-01	DIANA DECOLONGON	2020-11-09
507	2012-01-01	KATHLEEN CASTILLO
507	2011-01-01	KATHLEEN CASTILLO

Plan Statistics for UNUM 224167

401k plan membership statisitcs for UNUM 224167

Measure Date Value
2017: UNUM 224167 2017 401k membership
Total participants, beginning-of-year 2017-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 127
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 127
Number of employers contributing to the scheme 2017-01-01 0
2016: UNUM 224167 2016 401k membership
Total participants, beginning-of-year 2016-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 127
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 127
Number of employers contributing to the scheme 2016-01-01 0
2013: UNUM 224167 2013 401k membership
Total participants, beginning-of-year 2013-01-01 90
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 90
Total of all active and inactive participants 2013-01-01 90
Total participants 2013-01-01 90
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Number of employers contributing to the scheme 2013-01-01 0
2012: UNUM 224167 2012 401k membership
Total participants, beginning-of-year 2012-01-01 77
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 77
Total of all active and inactive participants 2012-01-01 77
Total participants 2012-01-01 77
2011: UNUM 224167 2011 401k membership
Total participants, beginning-of-year 2011-01-01 74
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 74
Total of all active and inactive participants 2011-01-01 74
Total participants 2011-01-01 74

Measure	Date	Value
2017: UNUM 224167 2017 401k membership
Total participants, beginning-of-year	2017-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	127
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	127
Number of employers contributing to the scheme	2017-01-01	0
2016: UNUM 224167 2016 401k membership
Total participants, beginning-of-year	2016-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	127
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	127
Number of employers contributing to the scheme	2016-01-01	0
2013: UNUM 224167 2013 401k membership
Total participants, beginning-of-year	2013-01-01	90
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	90
Total of all active and inactive participants	2013-01-01	90
Total participants	2013-01-01	90
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Number of employers contributing to the scheme	2013-01-01	0
2012: UNUM 224167 2012 401k membership
Total participants, beginning-of-year	2012-01-01	77
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	77
Total of all active and inactive participants	2012-01-01	77
Total participants	2012-01-01	77
2011: UNUM 224167 2011 401k membership
Total participants, beginning-of-year	2011-01-01	74
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	74
Total of all active and inactive participants	2011-01-01	74
Total participants	2011-01-01	74

Form 5500 Responses for UNUM 224167

2017: UNUM 224167 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: UNUM 224167 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2013: UNUM 224167 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: UNUM 224167 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
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 benefit arrangement – Insurance	Yes
2011: UNUM 224167 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

224167

Policy instance

Insurance contract or identification number	224167
Number of Individuals Covered	127
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

224167

Policy instance

Insurance contract or identification number	224167
Number of Individuals Covered	90
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,814
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $48,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,814
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	THE ROGOSIN INSTITUTE
Employer identification number (EIN):	133184198
NAIC Classification:	621492
NAIC Description:	Kidney Dialysis Centers