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SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 401k Plan overview

Plan NameSERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN
Plan identification number 001

SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

SERGEANTS BENEVOLENT ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:SERGEANTS BENEVOLENT ASSOCIATION
Employer identification number (EIN):136121923
NAIC Classification:561110
NAIC Description:Office Administrative Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-07-01DENNIS OSTERMANN2023-11-27
0012021-07-01DENNIS OSTERMANN2023-04-11
0012020-07-01DENNIS OSTERMANN2021-10-28
0012019-07-01DENNIS OSTERMANN2020-10-06
0012018-07-01DENNIS OSTERMANN2020-03-30
0012017-07-01DENNIS OSTERMANN2019-03-29
0012016-07-01DENNIS OSTERMANN
0012015-07-01DENNIS OSTERMANN
0012014-07-01DENNIS OSTERMANN
0012013-07-01DENNIS OSTERMANN
0012012-07-01DENNIS OSTERMANN
0012011-07-01DENNIS OSTERMANN
0012009-07-01DENNIS OSTERMANN
0012008-07-01DENNIS OSTERMANN

Plan Statistics for SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN

401k plan membership statisitcs for SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN

Measure Date Value
2016: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-0122
Total number of active participants reported on line 7a of the Form 55002016-07-0116
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-016
Total of all active and inactive participants2016-07-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-0122
Number of participants with account balances2016-07-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-07-010
2015: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-0119
Total number of active participants reported on line 7a of the Form 55002015-07-0116
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-016
Total of all active and inactive participants2015-07-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-0122
Number of participants with account balances2015-07-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-07-010
2014: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-0119
Total number of active participants reported on line 7a of the Form 55002014-07-0113
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-016
Total of all active and inactive participants2014-07-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
Total participants2014-07-0119
Number of participants with account balances2014-07-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-010
2013: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-0122
Total number of active participants reported on line 7a of the Form 55002013-07-0116
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-013
Total of all active and inactive participants2013-07-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-0119
Number of participants with account balances2013-07-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-010
2012: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-0122
Total number of active participants reported on line 7a of the Form 55002012-07-0120
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-012
Total of all active and inactive participants2012-07-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-0122
Number of participants with account balances2012-07-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-010
2011: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-0125
Total number of active participants reported on line 7a of the Form 55002011-07-0120
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-012
Total of all active and inactive participants2011-07-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-0122
Number of participants with account balances2011-07-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-010
2009: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-0119
Total number of active participants reported on line 7a of the Form 55002009-07-0116
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-013
Total of all active and inactive participants2009-07-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-0119
Number of participants with account balances2009-07-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-07-010
2008: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year2008-07-0119
Total number of active participants reported on line 7a of the Form 55002008-07-0115
Number of retired or separated participants receiving benefits2008-07-010
Number of other retired or separated participants entitled to future benefits2008-07-013
Total of all active and inactive participants2008-07-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-07-010
Total participants2008-07-0118
Number of participants with account balances2008-07-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-07-010

Financial Data on SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN

Measure Date Value
2017 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2017 401k financial data
Total income from all sources2017-06-30$322,697
Expenses. Total of all expenses incurred2017-06-30$28,000
Benefits paid (including direct rollovers)2017-06-30$28,000
Total plan assets at end of year2017-06-30$2,376,448
Total plan assets at beginning of year2017-06-30$2,081,751
Value of fidelity bond covering the plan2017-06-30$500,000
Total contributions received or receivable from participants2017-06-30$121,293
Other income received2017-06-30$201,404
Net income (gross income less expenses)2017-06-30$294,697
Net plan assets at end of year (total assets less liabilities)2017-06-30$2,376,448
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$2,081,751
2016 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2016 401k financial data
Total income from all sources2016-06-30$253,777
Expenses. Total of all expenses incurred2016-06-30$33,346
Benefits paid (including direct rollovers)2016-06-30$33,346
Total plan assets at end of year2016-06-30$2,081,751
Total plan assets at beginning of year2016-06-30$1,861,320
Value of fidelity bond covering the plan2016-06-30$500,000
Total contributions received or receivable from participants2016-06-30$125,563
Other income received2016-06-30$2,528
Net income (gross income less expenses)2016-06-30$220,431
Net plan assets at end of year (total assets less liabilities)2016-06-30$2,081,751
Net plan assets at beginning of year (total assets less liabilities)2016-06-30$1,861,320
Total contributions received or receivable from employer(s)2016-06-30$125,686
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-06-30$0
2015 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2015 401k financial data
Total income from all sources2015-06-30$182,434
Expenses. Total of all expenses incurred2015-06-30$12,000
Benefits paid (including direct rollovers)2015-06-30$12,000
Total plan assets at end of year2015-06-30$1,861,320
Total plan assets at beginning of year2015-06-30$1,690,886
Value of fidelity bond covering the plan2015-06-30$500,000
Total contributions received or receivable from participants2015-06-30$121,205
Other income received2015-06-30$61,229
Net income (gross income less expenses)2015-06-30$170,434
Net plan assets at end of year (total assets less liabilities)2015-06-30$1,861,320
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$1,690,886
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-06-30$0
2014 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2014 401k financial data
Total income from all sources2014-06-30$394,228
Expenses. Total of all expenses incurred2014-06-30$58,934
Benefits paid (including direct rollovers)2014-06-30$58,934
Total plan assets at end of year2014-06-30$1,690,886
Total plan assets at beginning of year2014-06-30$1,355,592
Value of fidelity bond covering the plan2014-06-30$500,000
Total contributions received or receivable from participants2014-06-30$100,133
Other income received2014-06-30$184,643
Net income (gross income less expenses)2014-06-30$335,294
Net plan assets at end of year (total assets less liabilities)2014-06-30$1,690,886
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$1,355,592
Total contributions received or receivable from employer(s)2014-06-30$109,452
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-06-30$0
2013 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2013 401k financial data
Total income from all sources2013-06-30$206,273
Expenses. Total of all expenses incurred2013-06-30$71,887
Benefits paid (including direct rollovers)2013-06-30$71,887
Total plan assets at end of year2013-06-30$1,355,592
Total plan assets at beginning of year2013-06-30$1,221,206
Value of fidelity bond covering the plan2013-06-30$500,000
Total contributions received or receivable from participants2013-06-30$90,093
Other income received2013-06-30$116,180
Net income (gross income less expenses)2013-06-30$134,386
Net plan assets at end of year (total assets less liabilities)2013-06-30$1,355,592
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$1,221,206
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-06-30$0
2012 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2012 401k financial data
Total income from all sources2012-06-30$222,862
Expenses. Total of all expenses incurred2012-06-30$15,758
Benefits paid (including direct rollovers)2012-06-30$15,725
Total plan assets at end of year2012-06-30$1,221,206
Total plan assets at beginning of year2012-06-30$1,014,102
Value of fidelity bond covering the plan2012-06-30$500,000
Total contributions received or receivable from participants2012-06-30$87,082
Other income received2012-06-30$20,194
Net income (gross income less expenses)2012-06-30$207,104
Net plan assets at end of year (total assets less liabilities)2012-06-30$1,221,206
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$1,014,102
Total contributions received or receivable from employer(s)2012-06-30$115,586
Expenses. Administrative service providers (salaries,fees and commissions)2012-06-30$33
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-06-30$0
2011 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2011 401k financial data
Total income from all sources2011-06-30$297,632
Expenses. Total of all expenses incurred2011-06-30$39,215
Benefits paid (including direct rollovers)2011-06-30$39,215
Total plan assets at end of year2011-06-30$1,014,102
Total plan assets at beginning of year2011-06-30$755,685
Value of fidelity bond covering the plan2011-06-30$500,000
Total contributions received or receivable from participants2011-06-30$99,337
Other income received2011-06-30$141,514
Net income (gross income less expenses)2011-06-30$258,417
Net plan assets at end of year (total assets less liabilities)2011-06-30$1,014,102
Net plan assets at beginning of year (total assets less liabilities)2011-06-30$755,685
Total contributions received or receivable from employer(s)2011-06-30$56,781
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-06-30$0
2010 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-06-30$0
2009 : SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2009 401k financial data
Total income from all sources2009-06-30$33,512
Expenses. Total of all expenses incurred2009-06-30$32,760
Benefits paid (including direct rollovers)2009-06-30$32,738
Total plan assets at end of year2009-06-30$550,610
Total plan assets at beginning of year2009-06-30$549,858
Value of fidelity bond covering the plan2009-06-30$500,000
Total contributions received or receivable from participants2009-06-30$96,592
Expenses. Other expenses not covered elsewhere2009-06-30$22
Other income received2009-06-30$-125,123
Net income (gross income less expenses)2009-06-30$752
Net plan assets at end of year (total assets less liabilities)2009-06-30$550,610
Net plan assets at beginning of year (total assets less liabilities)2009-06-30$549,858
Total contributions received or receivable from employer(s)2009-06-30$62,043

Form 5500 Responses for SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN

2016: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement - TrustYes
2011: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement - TrustYes
2009: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes
2008: SERGEANTS BENEVOLENT ASSOCIATION OFFICE EMPLOYEES 401(K) PLAN 2008 form 5500 responses
2008-07-01Type of plan entitySingle employer plan
2008-07-01Submission has been amendedNo
2008-07-01This submission is the final filingNo
2008-07-01This return/report is a short plan year return/report (less than 12 months)No
2008-07-01Plan is a collectively bargained planNo
2008-07-01Plan funding arrangement – InsuranceYes
2008-07-01Plan funding arrangement – TrustYes
2008-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA28183
Policy instance 1
Insurance contract or identification numberGA28183
Number of Individuals Covered22
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
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 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?Yes
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA28183
Policy instance 1
Insurance contract or identification numberGA28183
Number of Individuals Covered19
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
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 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?Yes
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA31508-01
Policy instance 1
Insurance contract or identification numberGA31508-01
Number of Individuals Covered0
Insurance policy start date2013-07-01
Insurance policy end date2013-07-15
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 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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA28183
Policy instance 2
Insurance contract or identification numberGA28183
Number of Individuals Covered17
Insurance policy start date2013-07-15
Insurance policy end date2014-06-30
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 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?Yes
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA31508-01
Policy instance 1
Insurance contract or identification numberGA31508-01
Number of Individuals Covered19
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
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 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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA31508-01
Policy instance 1
Insurance contract or identification numberGA31508-01
Number of Individuals Covered18
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
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 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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA31508-01
Policy instance 1
Insurance contract or identification numberGA31508-01
Number of Individuals Covered18
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
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 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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberGA31508-01
Policy instance 1
Insurance contract or identification numberGA31508-01
Number of Individuals Covered18
Insurance policy start date2008-07-01
Insurance policy end date2009-06-30
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 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 BenefitNo
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

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