401k Plan data: NYLAG LIFE AND DISABILITY PLAN plan

NYLAG LIFE AND DISABILITY PLAN 401k Plan overview

Plan Name	NYLAG LIFE AND DISABILITY PLAN
Plan identification number	504

NYLAG LIFE AND DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

NEW YORK LEGAL ASSISTANCE GROUP has sponsored the creation of one or more 401k plans.

Company Name: NEW YORK LEGAL ASSISTANCE GROUP

Employer identification number (EIN): 133505428

NAIC Classification: 541190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NYLAG LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2016-04-01 CEPEDA JOHNSON
504 2016-04-01 CEPEDA JOHNSON
504 2015-04-01 CEPEDA JOHNSON
504 2014-04-01 CEPEDA JOHNSON
504 2013-04-01 CEPEDA JOHNSON
504 2012-04-01 CEPEDA JOHNSON

Plan id#	Filing Submission Date	Name of Administrator
504	2016-04-01	CEPEDA JOHNSON
504	2016-04-01	CEPEDA JOHNSON
504	2015-04-01	CEPEDA JOHNSON
504	2014-04-01	CEPEDA JOHNSON
504	2013-04-01	CEPEDA JOHNSON
504	2012-04-01	CEPEDA JOHNSON

Plan Statistics for NYLAG LIFE AND DISABILITY PLAN

401k plan membership statisitcs for NYLAG LIFE AND DISABILITY PLAN

Measure Date Value
2016: NYLAG LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 222
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 0
Number of retired or separated participants receiving benefits 2016-04-01 0
Number of other retired or separated participants entitled to future benefits 2016-04-01 0
Total of all active and inactive participants 2016-04-01 0
2015: NYLAG LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-01 166
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 222
Number of retired or separated participants receiving benefits 2015-04-01 0
Number of other retired or separated participants entitled to future benefits 2015-04-01 0
Total of all active and inactive participants 2015-04-01 222
2014: NYLAG LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-04-01 121
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 164
Number of retired or separated participants receiving benefits 2014-04-01 0
Number of other retired or separated participants entitled to future benefits 2014-04-01 0
Total of all active and inactive participants 2014-04-01 164
2013: NYLAG LIFE AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-04-01 101
Total number of active participants reported on line 7a of the Form 5500 2013-04-01 121
Number of retired or separated participants receiving benefits 2013-04-01 0
Number of other retired or separated participants entitled to future benefits 2013-04-01 0
Total of all active and inactive participants 2013-04-01 121
2012: NYLAG LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-04-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 101
Number of retired or separated participants receiving benefits 2012-04-01 0
Number of other retired or separated participants entitled to future benefits 2012-04-01 0
Total of all active and inactive participants 2012-04-01 101

Measure	Date	Value
2016: NYLAG LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	222
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	0
Number of retired or separated participants receiving benefits	2016-04-01	0
Number of other retired or separated participants entitled to future benefits	2016-04-01	0
Total of all active and inactive participants	2016-04-01	0
2015: NYLAG LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-01	166
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	222
Number of retired or separated participants receiving benefits	2015-04-01	0
Number of other retired or separated participants entitled to future benefits	2015-04-01	0
Total of all active and inactive participants	2015-04-01	222
2014: NYLAG LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-04-01	121
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	164
Number of retired or separated participants receiving benefits	2014-04-01	0
Number of other retired or separated participants entitled to future benefits	2014-04-01	0
Total of all active and inactive participants	2014-04-01	164
2013: NYLAG LIFE AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-04-01	101
Total number of active participants reported on line 7a of the Form 5500	2013-04-01	121
Number of retired or separated participants receiving benefits	2013-04-01	0
Number of other retired or separated participants entitled to future benefits	2013-04-01	0
Total of all active and inactive participants	2013-04-01	121
2012: NYLAG LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-04-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	101
Number of retired or separated participants receiving benefits	2012-04-01	0
Number of other retired or separated participants entitled to future benefits	2012-04-01	0
Total of all active and inactive participants	2012-04-01	101

Form 5500 Responses for NYLAG LIFE AND DISABILITY PLAN

2016: NYLAG LIFE AND DISABILITY PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Submission has been amended	No
2016-04-01	This submission is the final filing	Yes
2016-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-04-01	Plan is a collectively bargained plan	No
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: NYLAG LIFE AND DISABILITY PLAN 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Submission has been amended	No
2015-04-01	This submission is the final filing	No
2015-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-04-01	Plan is a collectively bargained plan	No
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2014: NYLAG LIFE AND DISABILITY PLAN 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	Submission has been amended	No
2014-04-01	This submission is the final filing	No
2014-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-04-01	Plan is a collectively bargained plan	No
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes
2013: NYLAG LIFE AND DISABILITY PLAN 2013 form 5500 responses
2013-04-01	Type of plan entity	Single employer plan
2013-04-01	Submission has been amended	No
2013-04-01	This submission is the final filing	No
2013-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-04-01	Plan is a collectively bargained plan	No
2013-04-01	Plan funding arrangement – Insurance	Yes
2013-04-01	Plan benefit arrangement – Insurance	Yes
2012: NYLAG LIFE AND DISABILITY PLAN 2012 form 5500 responses
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	First time form 5500 has been submitted	Yes
2012-04-01	Submission has been amended	No
2012-04-01	This submission is the final filing	No
2012-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-04-01	Plan is a collectively bargained plan	No
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

823464

Policy instance

Insurance contract or identification number	823464
Number of Individuals Covered	199
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $12,719
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM
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 $99,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,956
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS, INC.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

823464

Policy instance

Insurance contract or identification number	823464
Number of Individuals Covered	222
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $16,649
Total amount of fees paid to insurance company	USD $2,213
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM
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 $93,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,755
Insurance broker organization code?	3
Amount paid for insurance broker fees	2213
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	PROFESSIONAL GROUP PLANS, INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

457692

Policy instance

Insurance contract or identification number	457692
Number of Individuals Covered	164
Insurance policy start date	2013-07-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $4,964
Total amount of fees paid to insurance company	USD $492
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	Yes
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 $65,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,964
Insurance broker organization code?	3
Amount paid for insurance broker fees	492
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	NEW YORK LIFE SECURITES, LLC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

457692

Policy instance

Insurance contract or identification number	457692
Number of Individuals Covered	121
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $5,340
Total amount of fees paid to insurance company	USD $383
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	Yes
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 $51,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,340
Insurance broker organization code?	3
Amount paid for insurance broker fees	383
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	NEW YORK LIFE SECURITES, LLC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

457692

Policy instance

Insurance contract or identification number	457692
Number of Individuals Covered	101
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $4,778
Total amount of fees paid to insurance company	USD $447
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	Yes
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 $44,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,778
Insurance broker organization code?	3
Amount paid for insurance broker fees	447
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	NEW YORK LIFE SECURITES, LLC

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Company Name:	NEW YORK LEGAL ASSISTANCE GROUP
Employer identification number (EIN):	133505428
NAIC Classification:	541190