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ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 401k Plan overview

Plan NameALZHEIMERS DISEASE AND RELATED DISORDERS ASSN
Plan identification number 001

ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN INC NWO has sponsored the creation of one or more 401k plans.

Company Name:ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN INC NWO
Employer identification number (EIN):341423768
NAIC Classification:624410
NAIC Description:Child Day Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01JEANNINE LEHMAN2023-09-11 VINCE MCGRAIL2023-09-13
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01
0012012-01-01SALLI BOLLIN SALLI BOLLIN2013-07-31
0012011-01-01SALLI BOLLIN SALLI BOLLIN2012-10-03

Plan Statistics for ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN

401k plan membership statisitcs for ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN

Measure Date Value
2017: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2017 401k membership
Total participants, beginning-of-year2017-01-0132
Total number of active participants reported on line 7a of the Form 55002017-01-0119
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0112
Total of all active and inactive participants2017-01-0131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0131
Number of participants with account balances2017-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2016 401k membership
Total participants, beginning-of-year2016-01-0132
Total number of active participants reported on line 7a of the Form 55002016-01-0119
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0113
Total of all active and inactive participants2016-01-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0132
Number of participants with account balances2016-01-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-014
2015: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2015 401k membership
Total participants, beginning-of-year2015-01-0134
Total number of active participants reported on line 7a of the Form 55002015-01-0122
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-019
Total of all active and inactive participants2015-01-0131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-011
Total participants2015-01-0132
Number of participants with account balances2015-01-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-014
2014: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2014 401k membership
Total participants, beginning-of-year2014-01-0129
Total number of active participants reported on line 7a of the Form 55002014-01-0129
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-015
Total of all active and inactive participants2014-01-0134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0134
Number of participants with account balances2014-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2013 401k membership
Total participants, beginning-of-year2013-01-0129
Total number of active participants reported on line 7a of the Form 55002013-01-0126
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-013
Total of all active and inactive participants2013-01-0129
Total participants2013-01-0129
Number of participants with account balances2013-01-0129
2012: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2012 401k membership
Total participants, beginning-of-year2012-01-0140
Total number of active participants reported on line 7a of the Form 55002012-01-0126
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0129
Number of participants with account balances2012-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2011 401k membership
Total participants, beginning-of-year2011-01-0135
Total number of active participants reported on line 7a of the Form 55002011-01-0139
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-0140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0140
Number of participants with account balances2011-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010

Financial Data on ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN

Measure Date Value
2017 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2017 401k financial data
Total income from all sources2017-12-31$40,100
Expenses. Total of all expenses incurred2017-12-31$30,311
Benefits paid (including direct rollovers)2017-12-31$30,015
Total plan assets at end of year2017-12-31$327,831
Total plan assets at beginning of year2017-12-31$318,042
Value of fidelity bond covering the plan2017-12-31$450,000
Total contributions received or receivable from participants2017-12-31$2,142
Other income received2017-12-31$29,712
Net income (gross income less expenses)2017-12-31$9,789
Net plan assets at end of year (total assets less liabilities)2017-12-31$327,831
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$318,042
Total contributions received or receivable from employer(s)2017-12-31$8,246
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$296
2016 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2016 401k financial data
Total income from all sources2016-12-31$100,393
Expenses. Total of all expenses incurred2016-12-31$13,582
Benefits paid (including direct rollovers)2016-12-31$13,245
Total plan assets at end of year2016-12-31$318,042
Total plan assets at beginning of year2016-12-31$231,231
Value of fidelity bond covering the plan2016-12-31$450,000
Total contributions received or receivable from participants2016-12-31$55,704
Expenses. Other expenses not covered elsewhere2016-12-31$337
Other income received2016-12-31$16,534
Net income (gross income less expenses)2016-12-31$86,811
Net plan assets at end of year (total assets less liabilities)2016-12-31$318,042
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$231,231
Total contributions received or receivable from employer(s)2016-12-31$28,155
2015 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2015 401k financial data
Total income from all sources2015-12-31$41,743
Expenses. Total of all expenses incurred2015-12-31$7,209
Benefits paid (including direct rollovers)2015-12-31$7,034
Total plan assets at end of year2015-12-31$231,231
Total plan assets at beginning of year2015-12-31$196,697
Value of fidelity bond covering the plan2015-12-31$450,000
Total contributions received or receivable from participants2015-12-31$36,968
Expenses. Other expenses not covered elsewhere2015-12-31$175
Other income received2015-12-31$-4,290
Net income (gross income less expenses)2015-12-31$34,534
Net plan assets at end of year (total assets less liabilities)2015-12-31$231,231
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$196,697
Total contributions received or receivable from employer(s)2015-12-31$9,065
2014 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2014 401k financial data
Total income from all sources2014-12-31$53,884
Expenses. Total of all expenses incurred2014-12-31$521
Benefits paid (including direct rollovers)2014-12-31$521
Total plan assets at end of year2014-12-31$196,697
Total plan assets at beginning of year2014-12-31$143,334
Value of fidelity bond covering the plan2014-12-31$450,000
Total contributions received or receivable from participants2014-12-31$30,734
Other income received2014-12-31$9,683
Net income (gross income less expenses)2014-12-31$53,363
Net plan assets at end of year (total assets less liabilities)2014-12-31$196,697
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$143,334
Total contributions received or receivable from employer(s)2014-12-31$13,467
2013 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2013 401k financial data
Total income from all sources2013-12-31$34,318
Expenses. Total of all expenses incurred2013-12-31$20,448
Benefits paid (including direct rollovers)2013-12-31$20,448
Total plan assets at end of year2013-12-31$143,334
Total plan assets at beginning of year2013-12-31$129,464
Value of fidelity bond covering the plan2013-12-31$450,000
Total contributions received or receivable from participants2013-12-31$11,769
Other income received2013-12-31$9,181
Net income (gross income less expenses)2013-12-31$13,870
Net plan assets at end of year (total assets less liabilities)2013-12-31$143,334
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$129,464
Total contributions received or receivable from employer(s)2013-12-31$13,368
2012 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2012 401k financial data
Total income from all sources2012-12-31$38,705
Expenses. Total of all expenses incurred2012-12-31$501
Benefits paid (including direct rollovers)2012-12-31$501
Total plan assets at end of year2012-12-31$129,464
Total plan assets at beginning of year2012-12-31$91,260
Value of fidelity bond covering the plan2012-12-31$450,000
Total contributions received or receivable from participants2012-12-31$7,390
Contributions received from other sources (not participants or employers)2012-12-31$15,243
Other income received2012-12-31$4,242
Net income (gross income less expenses)2012-12-31$38,204
Net plan assets at end of year (total assets less liabilities)2012-12-31$129,464
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$91,260
Total contributions received or receivable from employer(s)2012-12-31$11,830
2011 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2011 401k financial data
Transfers to/from the plan2011-12-31$2,949
Total income from all sources2011-12-31$23,022
Expenses. Total of all expenses incurred2011-12-31$1,663
Benefits paid (including direct rollovers)2011-12-31$1,663
Total plan assets at end of year2011-12-31$91,260
Total plan assets at beginning of year2011-12-31$66,952
Total contributions received or receivable from participants2011-12-31$10,801
Other income received2011-12-31$987
Net income (gross income less expenses)2011-12-31$21,359
Net plan assets at end of year (total assets less liabilities)2011-12-31$91,260
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$66,952
Total contributions received or receivable from employer(s)2011-12-31$11,234
2010 : ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2010 401k financial data
Total income from all sources2010-12-31$20,967
Expenses. Total of all expenses incurred2010-12-31$903
Benefits paid (including direct rollovers)2010-12-31$903
Total plan assets at end of year2010-12-31$66,952
Total plan assets at beginning of year2010-12-31$46,888
Total contributions received or receivable from participants2010-12-31$2,440
Contributions received from other sources (not participants or employers)2010-12-31$3,784
Other income received2010-12-31$-274
Net income (gross income less expenses)2010-12-31$20,064
Net plan assets at end of year (total assets less liabilities)2010-12-31$66,952
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$46,888
Total contributions received or receivable from employer(s)2010-12-31$15,017

Form 5500 Responses for ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN

2017: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 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 funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 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 funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 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 funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 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 funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: ALZHEIMERS DISEASE AND RELATED DISORDERS ASSN 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 funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058228-A
Policy instance 1
Insurance contract or identification number058228-A
Number of Individuals Covered32
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $317
Are there contracts with allocated funds for group deferred annuity?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees317
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameSOUTHFIELD REGIONAL OFFICE
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number388525
Policy instance 2
Insurance contract or identification number388525
Number of Individuals Covered9
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058228-A
Policy instance 1
Insurance contract or identification number058228-A
Number of Individuals Covered32
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $38
Are there contracts with allocated funds for group deferred annuity?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees38
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameSOUTHFIELD REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058228-A
Policy instance 1
Insurance contract or identification number058228-A
Number of Individuals Covered34
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $38
Are there contracts with allocated funds for group deferred annuity?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees38
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameSOUTHFIELD REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058228-A
Policy instance 1
Insurance contract or identification number058228-A
Number of Individuals Covered29
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $55
Are there contracts with allocated funds for group deferred annuity?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees55
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameSOUTHFIELD REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number58228-A
Policy instance 1
Insurance contract or identification number58228-A
Number of Individuals Covered29
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?Yes
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
Amount paid for insurance broker fees15
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker organization code?3
Insurance broker nameANTHONY ROGALSKI
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number58228-A
Policy instance 1
Insurance contract or identification number58228-A
Number of Individuals Covered27
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $95
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?Yes
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
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number58228-A
Policy instance 1
Insurance contract or identification number58228-A
Number of Individuals Covered23
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?Yes
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

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