MARRIOTT INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 580 | 2017-01-01 | JUDY FENNIMORE, VP BENEFITS | | CAROLYN HANDLON, EXEC VP TREASURER | 2018-10-09 |
| 580 | 2016-01-01 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2017-10-09 |
| 580 | 2015-01-01 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2016-10-10 |
| 580 | 2014-01-01 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2015-10-06 |
| 580 | 2013-01-01 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2014-10-02 |
| 580 | 2012-01-01 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2013-10-04 |
| 580 | 2011-01-01 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2012-11-02 |
| 580 | 2010-01-02 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2011-10-03 |
| 580 | 2009-01-03 | TRACEY BALLOW SR VP COMP BENEFIT | | CAROLYN HANDLON, EXEC VP TREASURER | 2010-09-29 |
401k plan membership statisitcs for MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN
| Measure | Date | Value |
|---|
| 2017: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 17,470 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 0 |
| 2016: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 16,746 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 17,470 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 17,470 |
| 2015: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 16,333 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 16,746 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 16,746 |
| 2014: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 16,239 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 16,333 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 16,333 |
| 2013: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 17,225 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 16,239 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 16,239 |
| 2012: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 16,427 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 17,225 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 17,225 |
| 2011: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 18,126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 16,427 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 16,427 |
| 2010: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-02 | 17,940 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-02 | 18,126 |
| Number of retired or separated participants receiving benefits | 2010-01-02 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-02 | 0 |
| Total of all active and inactive participants | 2010-01-02 | 18,126 |
| 2009: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-03 | 16,662 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-03 | 17,940 |
| Number of retired or separated participants receiving benefits | 2009-01-03 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-03 | 0 |
| Total of all active and inactive participants | 2009-01-03 | 17,940 |
| 2017: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | Yes |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | Yes |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2010 form 5500 responses |
|---|
| 2010-01-02 | Type of plan entity | Single employer plan |
| 2010-01-02 | Submission has been amended | No |
| 2010-01-02 | This submission is the final filing | No |
| 2010-01-02 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2010-01-02 | Plan is a collectively bargained plan | No |
| 2010-01-02 | Plan funding arrangement – Insurance | Yes |
| 2010-01-02 | Plan benefit arrangement – Insurance | Yes |
| 2009: MARRIOTT INTERNATIONAL, INC. BUSINESS TRAVEL ACCIDENT PLAN 2009 form 5500 responses |
|---|
| 2009-01-03 | Type of plan entity | Single employer plan |
| 2009-01-03 | Submission has been amended | No |
| 2009-01-03 | This submission is the final filing | No |
| 2009-01-03 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-01-03 | Plan is a collectively bargained plan | No |
| 2009-01-03 | Plan funding arrangement – Insurance | Yes |
| 2009-01-03 | Plan benefit arrangement – Insurance | Yes |
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9043755-B |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 9043755-B | | Number of Individuals Covered | 23267 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $10,737 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9043755-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 9043755-A | | Number of Individuals Covered | 16746 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $7,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9043755-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 9043755-A | | Number of Individuals Covered | 16333 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $7,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9043755-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 9043755-A | | Number of Individuals Covered | 16239 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $7,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9043755-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 9043755-A | | Number of Individuals Covered | 17225 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $7,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9043755-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 9043755-A | | Number of Individuals Covered | 16427 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $12,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9043755-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 9043755-A | | Number of Individuals Covered | 18126 | | Insurance policy start date | 2010-01-02 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $12,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PETERSEN INTERNATIONAL UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | 0829003 |
| Policy instance | 2 |
| Insurance contract or identification number | 0829003 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2009-07-05 | | Insurance policy end date | 2010-07-05 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFITS FOR BUSINESS TRAVEL | | 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 $1,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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