401k Plan data: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY plan

LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 401k Plan overview

Plan Name	LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY
Plan identification number	502

LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY Benefits

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

401k Sponsoring company profile

UTICA MUTUAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: UTICA MUTUAL INSURANCE COMPANY

Employer identification number (EIN): 150476880

NAIC Classification: 524290

Additional information about UTICA MUTUAL INSURANCE COMPANY

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2016-10-20

Company Identification Number: 604050180

Legal Registered Office Address: 7322 58TH STREET CT W APT 15-103

UNIVERSITY PLACE
United States of America (USA)
984674613

More information about UTICA MUTUAL INSURANCE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01 GAIL STEDMAN
502 2017-01-01
502 2016-01-01 GAIL STEDMAN
502 2015-01-01 GAIL STEDMAN
502 2014-01-01 GAIL STEDMAN
502 2013-01-01 GAIL STEDMAN
502 2012-01-01 GAIL STEDMAN
502 2011-01-01 GAIL STEDMAN
502 2009-01-01 GAIL STEDMAN

Plan Statistics for LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY

401k plan membership statisitcs for LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY

Measure Date Value
2017: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 828
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 780
Number of retired or separated participants receiving benefits 2017-01-01 31
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 811
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 811
2016: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 856
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 779
Number of retired or separated participants receiving benefits 2016-01-01 49
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 828
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 828
2015: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 889
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 811
Number of retired or separated participants receiving benefits 2015-01-01 45
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 856
Total participants 2015-01-01 856
2014: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 949
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 847
Number of retired or separated participants receiving benefits 2014-01-01 42
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 889
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 889
2013: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,009
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 904
Number of retired or separated participants receiving benefits 2013-01-01 45
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 949
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 949
2012: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,034
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 969
Number of retired or separated participants receiving benefits 2012-01-01 40
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1,009
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1,009
2011: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,082
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 999
Number of retired or separated participants receiving benefits 2011-01-01 35
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 1,034
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,034
2009: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,207
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,053
Number of retired or separated participants receiving benefits 2009-01-01 37
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 1,090
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,090

Measure	Date	Value
2017: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	828
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	780
Number of retired or separated participants receiving benefits	2017-01-01	31
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	811
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	811
2016: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	856
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	779
Number of retired or separated participants receiving benefits	2016-01-01	49
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	828
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	828
2015: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	889
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	811
Number of retired or separated participants receiving benefits	2015-01-01	45
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	856
Total participants	2015-01-01	856
2014: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	949
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	847
Number of retired or separated participants receiving benefits	2014-01-01	42
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	889
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	889
2013: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,009
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	904
Number of retired or separated participants receiving benefits	2013-01-01	45
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	949
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	949
2012: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,034
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	969
Number of retired or separated participants receiving benefits	2012-01-01	40
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1,009
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1,009
2011: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,082
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	999
Number of retired or separated participants receiving benefits	2011-01-01	35
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	1,034
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,034
2009: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,207
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,053
Number of retired or separated participants receiving benefits	2009-01-01	37
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	1,090
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,090

Form 5500 Responses for LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY

2017: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 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 benefit arrangement – Insurance	Yes
2016: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 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 benefit arrangement – Insurance	Yes
2015: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 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 benefit arrangement – Insurance	Yes
2014: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 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 benefit arrangement – Insurance	Yes
2011: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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
2009: LONG TERM DISABILITY PLAN OF UTICA MUTUAL INSURANCE COMPANY 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GF3-880-054556-

Policy instance

Insurance contract or identification number	GF3-880-054556-
Number of Individuals Covered	780
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $15,368
Total amount of fees paid to insurance company	USD $6,754
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	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 $334,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,368
Amount paid for insurance broker fees	6754
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LAWLEY BENEFITS GROUP LLC

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Company Name:	UTICA MUTUAL INSURANCE COMPANY
Employer identification number (EIN):	150476880
NAIC Classification:	524290

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2016-10-20
Company Identification Number:	604050180
Legal Registered Office Address:	7322 58TH STREET CT W APT 15-103 UNIVERSITY PLACE United States of America (USA) 984674613

Plan id#	Filing Submission Date	Name of Administrator
502	2017-01-01	GAIL STEDMAN
502	2017-01-01
502	2016-01-01	GAIL STEDMAN
502	2015-01-01	GAIL STEDMAN
502	2014-01-01	GAIL STEDMAN
502	2013-01-01	GAIL STEDMAN
502	2012-01-01	GAIL STEDMAN
502	2011-01-01	GAIL STEDMAN
502	2009-01-01	GAIL STEDMAN