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CHDI MANAGEMENT, INC. 401K PLAN 401k Plan overview

Plan NameCHDI MANAGEMENT, INC. 401K PLAN
Plan identification number 001

CHDI MANAGEMENT, INC. 401K PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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

CHDI MANAGEMENT, INC. has sponsored the creation of one or more 401k plans.

Company Name:CHDI MANAGEMENT, INC.
Employer identification number (EIN):450488835
NAIC Classification:541600

Additional information about CHDI MANAGEMENT, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 2002-10-21
Company Identification Number: 2825140
Legal Registered Office Address: 28 LIBERTY ST.
New York
NEW YORK
United States of America (USA)
10005

More information about CHDI MANAGEMENT, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHDI MANAGEMENT, INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01ROBI BLUMENSTEIN2020-10-05
0012018-01-01ROBI BLUMENSTEIN2019-10-15
0012017-01-01ROBI BLUMENSTEIN2018-08-01
0012016-01-01ROBI BLUMENSTEIN2017-08-22
0012015-01-01ROBI BLUMENSTEIN2016-08-10
0012014-01-01ROBI BLUMENSTEIN2015-09-16
0012013-01-01ROBI BLUMENSTEIN2014-09-03
0012012-01-01ROBI BLUMENSTEIN2013-08-28
0012011-01-01ROBI BLUMENSTEIN2012-06-19
0012010-01-01ROBI BLUMENSTEIN2011-09-08

Plan Statistics for CHDI MANAGEMENT, INC. 401K PLAN

401k plan membership statisitcs for CHDI MANAGEMENT, INC. 401K PLAN

Measure Date Value
2022: CHDI MANAGEMENT, INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01125
Total number of active participants reported on line 7a of the Form 55002022-01-01125
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0125
Total of all active and inactive participants2022-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01150
Number of participants with account balances2022-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-012
2021: CHDI MANAGEMENT, INC. 401K PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01140
Total number of active participants reported on line 7a of the Form 55002021-01-01115
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0112
Total of all active and inactive participants2021-01-01127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01127
Number of participants with account balances2021-01-01123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-015
2020: CHDI MANAGEMENT, INC. 401K PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01121
Total number of active participants reported on line 7a of the Form 55002020-01-01124
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0116
Total of all active and inactive participants2020-01-01140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01140
Number of participants with account balances2020-01-01134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0110

Financial Data on CHDI MANAGEMENT, INC. 401K PLAN

Measure Date Value
2022 : CHDI MANAGEMENT, INC. 401K PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$0
Total transfer of assets from this plan2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-1,236,211
Total loss/gain on sale of assets2022-12-31$-25,870
Total of all expenses incurred2022-12-31$508,812
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$481,819
Expenses. Certain deemed distributions of participant loans2022-12-31$0
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,565,158
Value of total assets at end of year2022-12-31$17,945,255
Value of total assets at beginning of year2022-12-31$19,690,278
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$26,993
Total interest from all sources2022-12-31$2,849
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$154,054
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$154,054
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,508,470
Participant contributions at end of year2022-12-31$49,515
Participant contributions at beginning of year2022-12-31$34,208
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$56,688
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$26,993
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-1,745,023
Value of net assets at end of year (total assets less liabilities)2022-12-31$17,945,255
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$19,690,278
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$16,819,781
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$18,638,197
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$1,337
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$1,512
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$1,075,959
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$1,017,873
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$0
Net investment gain/loss from pooled separate accounts2022-12-31$-2,932,069
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$0
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$481,819
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$413,433
Aggregate carrying amount (costs) on sale of assets2022-12-31$439,303
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31PKF O'CONNOR DAVIES, LLP.
Accountancy firm EIN2022-12-31271728945
2021 : CHDI MANAGEMENT, INC. 401K PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$4,178,675
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,001,504
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,001,151
Expenses. Certain deemed distributions of participant loans2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,505,625
Value of total assets at end of year2021-12-31$19,690,278
Value of total assets at beginning of year2021-12-31$16,513,107
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$353
Total interest from all sources2021-12-31$9,569
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,501,197
Participant contributions at end of year2021-12-31$34,208
Participant contributions at beginning of year2021-12-31$37,143
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$4,428
Other income not declared elsewhere2021-12-31$0
Administrative expenses (other) incurred2021-12-31$353
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$3,177,171
Value of net assets at end of year (total assets less liabilities)2021-12-31$19,690,278
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$16,513,107
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$18,638,197
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$15,683,232
Interest on participant loans2021-12-31$933
Interest earned on other investments2021-12-31$8,636
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$1,017,873
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$792,732
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Net investment gain/loss from pooled separate accounts2021-12-31$2,663,481
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,001,151
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN2021-12-31271728945
2020 : CHDI MANAGEMENT, INC. 401K PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$4,107,238
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$566,851
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$566,404
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$2,043,414
Value of total assets at end of year2020-12-31$16,513,107
Value of total assets at beginning of year2020-12-31$12,972,720
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$447
Total interest from all sources2020-12-31$13,722
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,482,177
Participant contributions at end of year2020-12-31$37,143
Participant contributions at beginning of year2020-12-31$57,005
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$561,237
Other income not declared elsewhere2020-12-31$2
Administrative expenses (other) incurred2020-12-31$447
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$3,540,387
Value of net assets at end of year (total assets less liabilities)2020-12-31$16,513,107
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$12,972,720
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$15,683,232
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$11,636,110
Interest on participant loans2020-12-31$2,231
Interest earned on other investments2020-12-31$11,491
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$792,732
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$1,279,605
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Net investment gain/loss from pooled separate accounts2020-12-31$2,050,100
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$566,404
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN2020-12-31271728945

Form 5500 Responses for CHDI MANAGEMENT, INC. 401K PLAN

2022: CHDI MANAGEMENT, INC. 401K PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CHDI MANAGEMENT, INC. 401K PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: CHDI MANAGEMENT, INC. 401K PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number061502J
Policy instance 1
Insurance contract or identification number061502J
Number of Individuals Covered127
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,667
Are there contracts with allocated funds for individual policies?0
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 Administration1
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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees5667
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number061502J
Policy instance 1
Insurance contract or identification number061502J
Number of Individuals Covered140
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,667
Are there contracts with allocated funds for individual policies?0
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 Administration1
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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees5667
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3

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