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LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 401k Plan overview

Plan NameLONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008
Plan identification number 606

LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Long-term disability cover

401k Sponsoring company profile

THE DOW CHEMICAL COMPANY has sponsored the creation of one or more 401k plans.

Company Name:THE DOW CHEMICAL COMPANY
Employer identification number (EIN):381285128
NAIC Classification:325100

Additional information about THE DOW CHEMICAL COMPANY

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 0414128

More information about THE DOW CHEMICAL COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
6062022-01-01
6062021-01-01
6062020-01-01
6062019-01-01
6062018-01-01
6062017-01-01STEVEN MORGENSTERN BRYAN JENDRETZKE2018-10-15
6062014-01-01STEVEN MORGENSTERN BRYAN JENDRETZKE2015-09-24
6062013-01-01STEVEN MORGENSTERN BRYAN JENDRETZKE2014-09-18
6062012-01-01STEVEN MORGENSTERN DIANE DITTENHAFER2013-09-27
6062011-01-01STEVEN MORGENSTERN DIANE DITTENHAFER2012-10-02
6062010-01-01STEVEN MORGENSTERN DIANE DITTENHAFER2011-09-28
6062009-01-01STEVEN MORGENSTERN MICHAEL PERSONKE2010-09-29

Plan Statistics for LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008

401k plan membership statisitcs for LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008

Measure Date Value
2022: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2022 401k membership
Total participants, beginning-of-year2022-01-0116,748
Total number of active participants reported on line 7a of the Form 55002022-01-0117,881
Number of retired or separated participants receiving benefits2022-01-01136
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0118,017
2021: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2021 401k membership
Total participants, beginning-of-year2021-01-0114,317
Total number of active participants reported on line 7a of the Form 55002021-01-0116,749
Number of retired or separated participants receiving benefits2021-01-01141
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0116,890
2020: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2020 401k membership
Total participants, beginning-of-year2020-01-0117,151
Total number of active participants reported on line 7a of the Form 55002020-01-0116,730
Number of retired or separated participants receiving benefits2020-01-01152
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0116,882
2019: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2019 401k membership
Total participants, beginning-of-year2019-01-0123,913
Total number of active participants reported on line 7a of the Form 55002019-01-0117,147
Number of retired or separated participants receiving benefits2019-01-01163
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0117,310
2018: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2018 401k membership
Total participants, beginning-of-year2018-01-0124,131
Total number of active participants reported on line 7a of the Form 55002018-01-0123,916
Number of retired or separated participants receiving benefits2018-01-01178
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0124,094
2017: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2017 401k membership
Total participants, beginning-of-year2017-01-0124,829
Total number of active participants reported on line 7a of the Form 55002017-01-0123,970
Number of retired or separated participants receiving benefits2017-01-01167
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0124,137
2014: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2014 401k membership
Total participants, beginning-of-year2014-01-0123,551
Total number of active participants reported on line 7a of the Form 55002014-01-0123,810
Number of retired or separated participants receiving benefits2014-01-01156
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0123,966
2013: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2013 401k membership
Total participants, beginning-of-year2013-01-0124,016
Total number of active participants reported on line 7a of the Form 55002013-01-0123,359
Number of retired or separated participants receiving benefits2013-01-01192
Total of all active and inactive participants2013-01-0123,551
2012: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2012 401k membership
Total participants, beginning-of-year2012-01-0123,976
Total number of active participants reported on line 7a of the Form 55002012-01-0123,989
Number of retired or separated participants receiving benefits2012-01-01140
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0124,129
Total participants2012-01-0124,129
2011: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2011 401k membership
Total participants, beginning-of-year2011-01-0122,813
Total number of active participants reported on line 7a of the Form 55002011-01-0123,741
Number of retired or separated participants receiving benefits2011-01-01113
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0123,854
2010: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2010 401k membership
Total participants, beginning-of-year2010-01-0123,848
Total number of active participants reported on line 7a of the Form 55002010-01-0122,874
Number of retired or separated participants receiving benefits2010-01-0166
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0122,940
Total participants2010-01-0122,940
2009: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2009 401k membership
Total participants, beginning-of-year2009-01-0121,092
Total number of active participants reported on line 7a of the Form 55002009-01-0119,116
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0119,116
Total participants2009-01-0119,116

Form 5500 Responses for LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008

2022: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2014: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: LONG TERM DISABILITY PLAN FOR THOSE ACTIVELY AT WORK JANUARY 1, 2008 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberGF3 84043769301
Policy instance 1
Insurance contract or identification numberGF3 84043769301
Number of Individuals Covered17840
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,648,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberGF3 84043769301
Policy instance 1
Insurance contract or identification numberGF3 84043769301
Number of Individuals Covered16533
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,826,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3 84043769301
Policy instance 1
Insurance contract or identification numberGF3 84043769301
Number of Individuals Covered16861
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,852,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3 84043769301
Policy instance 1
Insurance contract or identification numberGF3 84043769301
Number of Individuals Covered17331
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $69,382
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,404,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees69382
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGS3 84043769301
Policy instance 2
Insurance contract or identification numberGS3 84043769301
Number of Individuals Covered27
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedHAWAII STATUTORY
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 CarrierUSD $2,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3 84043769301
Policy instance 1
Insurance contract or identification numberGF3 84043769301
Number of Individuals Covered23903
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $69,382
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,321,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees69382
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?4
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGS3 84043769301
Policy instance 2
Insurance contract or identification numberGS3 84043769301
Number of Individuals Covered39
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $178
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedHAWAII STATUTORY
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 CarrierUSD $15,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees178
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?4
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3 84043769301
Policy instance 1
Insurance contract or identification numberGF3 84043769301
Number of Individuals Covered24011
Insurance policy start date2016-12-01
Insurance policy end date2017-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,287,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGS3 84043769301
Policy instance 2
Insurance contract or identification numberGS3 84043769301
Number of Individuals Covered110
Insurance policy start date2016-12-01
Insurance policy end date2017-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedHAWAII STATUTORY
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 CarrierUSD $27,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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