401k Plan data: IBA HEALTH INS PLAN plan

IBA HEALTH INS PLAN 401k Plan overview

Plan Name	IBA HEALTH INS PLAN
Plan identification number	502

IBA HEALTH INS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

IRVING BURTON ASSOCIATES, INC. has sponsored the creation of one or more 401k plans.

Company Name: IRVING BURTON ASSOCIATES, INC.

Employer identification number (EIN): 541172222

NAIC Classification: 541600

Additional information about IRVING BURTON ASSOCIATES, INC.

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1981-06-12

Company Identification Number: 0218601

Legal Registered Office Address: 3150 FAIRVIEW PARK DRIVE
SUITE 301
FALLS CHURCH
United States of America (USA)
22042

More information about IRVING BURTON ASSOCIATES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IBA HEALTH INS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-07-01 ANNA RYAN 2020-07-13
502 2016-07-01 AMANDA COLLINS 2022-01-21
502 2015-07-01
502 2014-07-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2016-07-01			ANNA RYAN	2020-07-13
502	2016-07-01	AMANDA COLLINS	2022-01-21
502	2015-07-01
502	2014-07-01

Plan Statistics for IBA HEALTH INS PLAN

401k plan membership statisitcs for IBA HEALTH INS PLAN

Measure Date Value
2016: IBA HEALTH INS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 108
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 104
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-07-01 0
Total participants 2016-07-01 104
Number of employers contributing to the scheme 2016-07-01 0
2015: IBA HEALTH INS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 101
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 108
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 108
Total participants 2015-07-01 108
2014: IBA HEALTH INS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 83
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 101
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 101

Measure	Date	Value
2016: IBA HEALTH INS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	108
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	104
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-07-01	0
Total participants	2016-07-01	104
Number of employers contributing to the scheme	2016-07-01	0
2015: IBA HEALTH INS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	101
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	108
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	108
Total participants	2015-07-01	108
2014: IBA HEALTH INS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	83
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	101
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	101

Form 5500 Responses for IBA HEALTH INS PLAN

2016: IBA HEALTH INS PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: IBA HEALTH INS PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: IBA HEALTH INS PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	First time form 5500 has been submitted	Yes
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00611392

Policy instance

Insurance contract or identification number	00611392
Number of Individuals Covered	104
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,063,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

#010026463

Policy instance

Insurance contract or identification number	#010026463
Number of Individuals Covered	87
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $1,277
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,277
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00611392

Policy instance

Insurance contract or identification number	00611392
Number of Individuals Covered	108
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
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	Yes
Dental Insurance Welfare Benefit	Yes
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
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?	Yes

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

#010026463

Policy instance

Insurance contract or identification number	#010026463
Number of Individuals Covered	86
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,216
Total amount of fees paid to insurance company	USD $185
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	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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?	Yes
Commission paid to Insurance Broker	USD $1,216
Amount paid for insurance broker fees	185
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00611392

Policy instance

Insurance contract or identification number	00611392
Number of Individuals Covered	101
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
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	Yes
Dental Insurance Welfare Benefit	Yes
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
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?	Yes

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

#010026463

Policy instance

Insurance contract or identification number	#010026463
Number of Individuals Covered	80
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,331
Total amount of fees paid to insurance company	USD $203
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	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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?	Yes
Commission paid to Insurance Broker	USD $1,331
Amount paid for insurance broker fees	203
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3

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Company Name:	IRVING BURTON ASSOCIATES, INC.
Employer identification number (EIN):	541172222
NAIC Classification:	541600

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1981-06-12
Company Identification Number:	0218601
Legal Registered Office Address:	3150 FAIRVIEW PARK DRIVE SUITE 301 FALLS CHURCH United States of America (USA) 22042