401k Plan data: FLUSHING SAVINGS BANK, FSB plan

FLUSHING SAVINGS BANK, FSB 401k Plan overview

Plan Name	FLUSHING SAVINGS BANK, FSB
Plan identification number	503

FLUSHING SAVINGS BANK, FSB Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

FLUSHING SAVINGS BANK, FSB has sponsored the creation of one or more 401k plans.

Company Name: FLUSHING SAVINGS BANK, FSB

Employer identification number (EIN): 110758150

NAIC Classification: 522120
NAIC Description: Savings Institutions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FLUSHING SAVINGS BANK, FSB

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-01-01 JAMES ODAY
503 2011-01-01 NICOLE BALLATO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2012-01-01	JAMES ODAY
503	2011-01-01	NICOLE BALLATO

Plan Statistics for FLUSHING SAVINGS BANK, FSB

401k plan membership statisitcs for FLUSHING SAVINGS BANK, FSB

Measure Date Value
2012: FLUSHING SAVINGS BANK, FSB 2012 401k membership
Total participants, beginning-of-year 2012-01-01 510
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 516
Total of all active and inactive participants 2012-01-01 516
Total participants 2012-01-01 516
2011: FLUSHING SAVINGS BANK, FSB 2011 401k membership
Total participants, beginning-of-year 2011-01-01 510
Total of all active and inactive participants 2011-01-01 0
Total participants 2011-01-01 0

Measure	Date	Value
2012: FLUSHING SAVINGS BANK, FSB 2012 401k membership
Total participants, beginning-of-year	2012-01-01	510
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	516
Total of all active and inactive participants	2012-01-01	516
Total participants	2012-01-01	516
2011: FLUSHING SAVINGS BANK, FSB 2011 401k membership
Total participants, beginning-of-year	2011-01-01	510
Total of all active and inactive participants	2011-01-01	0
Total participants	2011-01-01	0

Financial Data on FLUSHING SAVINGS BANK, FSB

Measure	Date	Value
2011 : FLUSHING SAVINGS BANK, FSB 2011 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No

Form 5500 Responses for FLUSHING SAVINGS BANK, FSB

2012: FLUSHING SAVINGS BANK, FSB 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: FLUSHING SAVINGS BANK, FSB 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

098880

Policy instance

Insurance contract or identification number	098880
Number of Individuals Covered	267
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,815
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000470K

Policy instance

Insurance contract or identification number	G000470K
Number of Individuals Covered	351
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,466
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $12,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

GLCL0470K

Policy instance

Insurance contract or identification number	GLCL0470K
Number of Individuals Covered	80
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,857
Total amount of fees paid to insurance company	USD $1,344
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $33,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000470K

Policy instance

Insurance contract or identification number	G000470K
Number of Individuals Covered	325
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,123
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FSB-001

Policy instance

Insurance contract or identification number	FSB-001
Number of Individuals Covered	315
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,922
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000470K

Policy instance

Insurance contract or identification number	G000470K
Number of Individuals Covered	391
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,782
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000470K

Policy instance

Insurance contract or identification number	G000470K
Number of Individuals Covered	80
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $414
Total amount of fees paid to insurance company	USD $111
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $2,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

Policy instance

Number of Individuals Covered	13
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	MEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to Carrier	USD $40,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

FS1947

Policy instance

Insurance contract or identification number	FS1947
Number of Individuals Covered	507
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $70,590
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,813,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FLUSHING SAVINGS BANK, FSB
Employer identification number (EIN):	110758150
NAIC Classification:	522120
NAIC Description:	Savings Institutions