401k Plan data: FIRST COMMONWEALTH DMO DENTAL PLAN plan

FIRST COMMONWEALTH DMO DENTAL PLAN 401k Plan overview

Plan Name	FIRST COMMONWEALTH DMO DENTAL PLAN
Plan identification number	517

FIRST COMMONWEALTH DMO DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

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

Company Name: NORTHWESTERN UNIVERSITY

Employer identification number (EIN): 362167817

NAIC Classification: 611000

Additional information about NORTHWESTERN UNIVERSITY

Jurisdiction of Incorporation: Louisiana Secretary Of State, Commercial Division

Incorporation Date:

Company Identification Number: 34259176N

More information about NORTHWESTERN UNIVERSITY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST COMMONWEALTH DMO DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
517 2017-01-01 ANNE FISH
517 2017-01-01
517 2017-01-01
517 2016-01-01 ANNE FISH
517 2015-01-01 ANNE FISH
517 2014-01-01 ANNE N. FISH
517 2013-01-01 ANNE N. FISH, DIRECTOR OF BENEFITS ANNE N. FISH, DIRECTOR OF BENEFITS 2014-07-01
517 2012-01-01 ANNE N. FISH, DIRECTOR OF BENEFITS ANNE N. FISH, DIRECTOR OF BENEFITS 2013-07-17
517 2011-01-01 ANNE N. FISH, DIRECTOR OF BENEFITS ANNE N. FISH, DIRECTOR OF BENEFITS 2012-07-30
517 2009-01-01
517 2009-01-01 ANNE N. FISH, DIRECTOR OF BENEFITS ANNE N. FISH, DIRECTOR OF BENEFITS 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
517	2017-01-01	ANNE FISH
517	2017-01-01
517	2017-01-01
517	2016-01-01	ANNE FISH
517	2015-01-01	ANNE FISH
517	2014-01-01	ANNE N. FISH
517	2013-01-01	ANNE N. FISH, DIRECTOR OF BENEFITS	ANNE N. FISH, DIRECTOR OF BENEFITS	2014-07-01
517	2012-01-01	ANNE N. FISH, DIRECTOR OF BENEFITS	ANNE N. FISH, DIRECTOR OF BENEFITS	2013-07-17
517	2011-01-01	ANNE N. FISH, DIRECTOR OF BENEFITS	ANNE N. FISH, DIRECTOR OF BENEFITS	2012-07-30
517	2009-01-01
517	2009-01-01	ANNE N. FISH, DIRECTOR OF BENEFITS	ANNE N. FISH, DIRECTOR OF BENEFITS	2010-10-13

Plan Statistics for FIRST COMMONWEALTH DMO DENTAL PLAN

401k plan membership statisitcs for FIRST COMMONWEALTH DMO DENTAL PLAN

Measure Date Value
2017: FIRST COMMONWEALTH DMO DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,848
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,877
Number of retired or separated participants receiving benefits 2017-01-01 45
Total of all active and inactive participants 2017-01-01 1,922
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
2016: FIRST COMMONWEALTH DMO DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,846
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,805
Number of retired or separated participants receiving benefits 2016-01-01 43
Total of all active and inactive participants 2016-01-01 1,848
2015: FIRST COMMONWEALTH DMO DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,825
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,792
Number of retired or separated participants receiving benefits 2015-01-01 54
Total of all active and inactive participants 2015-01-01 1,846
2014: FIRST COMMONWEALTH DMO DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,945
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,767
Number of retired or separated participants receiving benefits 2014-01-01 58
Total of all active and inactive participants 2014-01-01 1,825
2013: FIRST COMMONWEALTH DMO DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,006
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,892
Number of retired or separated participants receiving benefits 2013-01-01 53
Total of all active and inactive participants 2013-01-01 1,945
2012: FIRST COMMONWEALTH DMO DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,947
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,951
Number of retired or separated participants receiving benefits 2012-01-01 55
Total of all active and inactive participants 2012-01-01 2,006
2011: FIRST COMMONWEALTH DMO DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,078
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2,012
Number of retired or separated participants receiving benefits 2011-01-01 37
Total of all active and inactive participants 2011-01-01 2,049
2009: FIRST COMMONWEALTH DMO DENTAL PLAN 2009 401k membership
Total of all active and inactive participants 2009-01-01 0
Total participants, beginning-of-year 2009-01-01 2,195
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2,140
Number of retired or separated participants receiving benefits 2009-01-01 56
Number of other retired or separated participants entitled to future benefits 2009-01-01 0

Measure	Date	Value
2017: FIRST COMMONWEALTH DMO DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,848
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,877
Number of retired or separated participants receiving benefits	2017-01-01	45
Total of all active and inactive participants	2017-01-01	1,922
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
2016: FIRST COMMONWEALTH DMO DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,846
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,805
Number of retired or separated participants receiving benefits	2016-01-01	43
Total of all active and inactive participants	2016-01-01	1,848
2015: FIRST COMMONWEALTH DMO DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,825
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,792
Number of retired or separated participants receiving benefits	2015-01-01	54
Total of all active and inactive participants	2015-01-01	1,846
2014: FIRST COMMONWEALTH DMO DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,945
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,767
Number of retired or separated participants receiving benefits	2014-01-01	58
Total of all active and inactive participants	2014-01-01	1,825
2013: FIRST COMMONWEALTH DMO DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,006
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,892
Number of retired or separated participants receiving benefits	2013-01-01	53
Total of all active and inactive participants	2013-01-01	1,945
2012: FIRST COMMONWEALTH DMO DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,947
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,951
Number of retired or separated participants receiving benefits	2012-01-01	55
Total of all active and inactive participants	2012-01-01	2,006
2011: FIRST COMMONWEALTH DMO DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,078
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,012
Number of retired or separated participants receiving benefits	2011-01-01	37
Total of all active and inactive participants	2011-01-01	2,049
2009: FIRST COMMONWEALTH DMO DENTAL PLAN 2009 401k membership
Total of all active and inactive participants	2009-01-01	0
Total participants, beginning-of-year	2009-01-01	2,195
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2,140
Number of retired or separated participants receiving benefits	2009-01-01	56
Number of other retired or separated participants entitled to future benefits	2009-01-01	0

Form 5500 Responses for FIRST COMMONWEALTH DMO DENTAL PLAN

2017: FIRST COMMONWEALTH DMO DENTAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
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: FIRST COMMONWEALTH DMO DENTAL PLAN 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: FIRST COMMONWEALTH DMO DENTAL PLAN 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: FIRST COMMONWEALTH DMO DENTAL PLAN 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: FIRST COMMONWEALTH DMO DENTAL PLAN 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: FIRST COMMONWEALTH DMO DENTAL PLAN 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: FIRST COMMONWEALTH DMO DENTAL PLAN 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: FIRST COMMONWEALTH DMO DENTAL PLAN 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

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00378954

Policy instance

Insurance contract or identification number	00378954
Number of Individuals Covered	1880
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 $5,436
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
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 $549,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5436
Additional information about fees paid to insurance broker	CONSULTING
Insurance broker organization code?	5
Insurance broker name	MERCER HEALTH & BENEFITS, LLC

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Company Name:	NORTHWESTERN UNIVERSITY
Employer identification number (EIN):	362167817
NAIC Classification:	611000

Jurisdiction of Incorporation:	Louisiana Secretary Of State, Commercial Division
Incorporation Date:
Company Identification Number:	34259176N