401k Plan data: JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY plan

JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY 401k Plan overview

Plan Name	JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY
Plan identification number	502

JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

JOHNSON CONTROLS DE PUERTO RICO INC. has sponsored the creation of one or more 401k plans.

Company Name: JOHNSON CONTROLS DE PUERTO RICO INC.

Employer identification number (EIN): 660533700

NAIC Classification: 334500

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-01-01 KAARE LEIN KAARE LEIN 2016-07-07
502 2014-01-01 SHERRY Z. WEINBERG 2015-10-14 SHERRY Z. WEINBERG 2015-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2015-01-01	KAARE LEIN		KAARE LEIN	2016-07-07
502	2014-01-01	SHERRY Z. WEINBERG	2015-10-14	SHERRY Z. WEINBERG	2015-10-14

Plan Statistics for JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY

401k plan membership statisitcs for JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY

Measure Date Value
2015: JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 285
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 44
Total of all active and inactive participants 2015-01-01 44
Total participants 2015-01-01 44
2014: JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 205
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 285
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 285

Measure	Date	Value
2015: JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	285
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	44
Total of all active and inactive participants	2015-01-01	44
Total participants	2015-01-01	44
2014: JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	205
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	285
Number of retired or separated participants receiving benefits	2014-01-01	0
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	285

Form 5500 Responses for JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY

2015: JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY 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: JOHNSON CONTROLS PUERTO RICO LIFE AND DISABILITY 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

Insurance Providers Used on plan

TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 )

Policy contract number

LTDR2-1301004

Policy instance

Insurance contract or identification number	LTDR2-1301004
Number of Individuals Covered	44
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,162
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,162
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	AON HEWITT

TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 )

Policy contract number

V-0201001

Policy instance

Insurance contract or identification number	V-0201001
Number of Individuals Covered	44
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,618
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $26,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,618
Insurance broker organization code?	3
Insurance broker name	AON HEWITT

TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 )

Policy contract number

LTDR2-1301004

Policy instance

Insurance contract or identification number	LTDR2-1301004
Number of Individuals Covered	263
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,996
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 $33,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,996
Insurance broker organization code?	3
Insurance broker name	AON HEWITT

TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 )

Policy contract number

V-0201001

Policy instance

Insurance contract or identification number	V-0201001
Number of Individuals Covered	308
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,013
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $41,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,013
Insurance broker organization code?	3
Insurance broker name	AON HEWITT

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Company Name:	JOHNSON CONTROLS DE PUERTO RICO INC.
Employer identification number (EIN):	660533700
NAIC Classification:	334500