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FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 401k Plan overview

Plan NameFAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN
Plan identification number 510

FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

FAMILY SECURITY CREDIT UNION has sponsored the creation of one or more 401k plans.

Company Name:FAMILY SECURITY CREDIT UNION
Employer identification number (EIN):630757453
NAIC Classification:522130
NAIC Description:Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102018-05-01JENNIFER CHENAULT2019-08-28
5102017-05-01
5102016-05-01
5102015-05-01ZAC HOWELL
5102014-05-01ZAC HOWELL
5102013-05-01ZAC HOWELL
5102012-05-01ZAC HOWELL
5102012-03-01ZAC HOWELL
5102011-03-01ZAC HOWELL
5102010-03-01ZAC HOWELL
5102009-03-01ZAC HOWELL
5102008-03-01ZAC HOWELL
5102007-03-01ZAC HOWELL
5102006-03-01ZAC HOWELL
5102005-03-01ZAC HOWELL

Plan Statistics for FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN

401k plan membership statisitcs for FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN

Measure Date Value
2018: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01170
Total number of active participants reported on line 7a of the Form 55002018-05-01177
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-01177
Number of employers contributing to the scheme2018-05-010
2017: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01172
Total number of active participants reported on line 7a of the Form 55002017-05-01170
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-01170
2016: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01164
Total number of active participants reported on line 7a of the Form 55002016-05-01172
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-01172
2015: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-01161
Total number of active participants reported on line 7a of the Form 55002015-05-01164
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01164
2014: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01160
Total number of active participants reported on line 7a of the Form 55002014-05-01161
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01161
2013: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01157
Total number of active participants reported on line 7a of the Form 55002013-05-01160
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-01160
2012: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01147
Total number of active participants reported on line 7a of the Form 55002012-05-01149
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-01149
Total participants, beginning-of-year2012-03-01147
Total number of active participants reported on line 7a of the Form 55002012-03-01150
Number of retired or separated participants receiving benefits2012-03-010
Number of other retired or separated participants entitled to future benefits2012-03-010
Total of all active and inactive participants2012-03-01150
2011: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-01144
Total number of active participants reported on line 7a of the Form 55002011-03-01146
Number of retired or separated participants receiving benefits2011-03-010
Number of other retired or separated participants entitled to future benefits2011-03-010
Total of all active and inactive participants2011-03-01146
2010: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-03-01139
Total number of active participants reported on line 7a of the Form 55002010-03-01144
Number of retired or separated participants receiving benefits2010-03-010
Number of other retired or separated participants entitled to future benefits2010-03-010
Total of all active and inactive participants2010-03-01144
2009: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-03-01138
Total number of active participants reported on line 7a of the Form 55002009-03-01142
Number of retired or separated participants receiving benefits2009-03-010
Number of other retired or separated participants entitled to future benefits2009-03-010
Total of all active and inactive participants2009-03-01142
Total participants2009-03-01142
2008: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-03-01123
Total number of active participants reported on line 7a of the Form 55002008-03-01135
Number of retired or separated participants receiving benefits2008-03-010
Number of other retired or separated participants entitled to future benefits2008-03-010
Total of all active and inactive participants2008-03-01135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-03-010
Total participants2008-03-01135
2007: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-03-01113
Total number of active participants reported on line 7a of the Form 55002007-03-01123
Number of retired or separated participants receiving benefits2007-03-010
Number of other retired or separated participants entitled to future benefits2007-03-010
Total of all active and inactive participants2007-03-01123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-03-010
Total participants2007-03-01123
2006: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-03-01119
Total number of active participants reported on line 7a of the Form 55002006-03-01113
Number of retired or separated participants receiving benefits2006-03-010
Number of other retired or separated participants entitled to future benefits2006-03-010
Total of all active and inactive participants2006-03-01113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2006-03-010
Total participants2006-03-01113
2005: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year2005-03-01104
Total number of active participants reported on line 7a of the Form 55002005-03-01119
Number of retired or separated participants receiving benefits2005-03-010
Number of other retired or separated participants entitled to future benefits2005-03-010
Total of all active and inactive participants2005-03-01119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2005-03-010
Total participants2005-03-01119

Form 5500 Responses for FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN

2018: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-03-01Type of plan entitySingle employer plan
2012-03-01Submission has been amendedNo
2012-03-01This submission is the final filingNo
2012-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-03-01Plan is a collectively bargained planNo
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Submission has been amendedYes
2011-03-01This submission is the final filingNo
2011-03-01This return/report is a short plan year return/report (less than 12 months)No
2011-03-01Plan is a collectively bargained planNo
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2010: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Submission has been amendedNo
2010-03-01This submission is the final filingNo
2010-03-01This return/report is a short plan year return/report (less than 12 months)No
2010-03-01Plan is a collectively bargained planNo
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – InsuranceYes
2009: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Submission has been amendedNo
2009-03-01This submission is the final filingNo
2009-03-01This return/report is a short plan year return/report (less than 12 months)No
2009-03-01Plan is a collectively bargained planNo
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes
2008: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-03-01Type of plan entitySingle employer plan
2008-03-01Submission has been amendedNo
2008-03-01This submission is the final filingNo
2008-03-01This return/report is a short plan year return/report (less than 12 months)No
2008-03-01Plan is a collectively bargained planNo
2008-03-01Plan funding arrangement – InsuranceYes
2008-03-01Plan benefit arrangement – InsuranceYes
2007: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2007 form 5500 responses
2007-03-01Type of plan entitySingle employer plan
2007-03-01Submission has been amendedNo
2007-03-01This submission is the final filingNo
2007-03-01This return/report is a short plan year return/report (less than 12 months)No
2007-03-01Plan is a collectively bargained planNo
2007-03-01Plan funding arrangement – InsuranceYes
2007-03-01Plan benefit arrangement – InsuranceYes
2006: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2006 form 5500 responses
2006-03-01Type of plan entitySingle employer plan
2006-03-01Submission has been amendedNo
2006-03-01This submission is the final filingNo
2006-03-01This return/report is a short plan year return/report (less than 12 months)No
2006-03-01Plan is a collectively bargained planNo
2006-03-01Plan funding arrangement – InsuranceYes
2006-03-01Plan benefit arrangement – InsuranceYes
2005: FAMILY SECURITY CREDIT UNION LIFE, ADD AND LTD WELFARE BENEFIT PLAN 2005 form 5500 responses
2005-03-01Type of plan entitySingle employer plan
2005-03-01First time form 5500 has been submittedYes
2005-03-01Submission has been amendedNo
2005-03-01This submission is the final filingNo
2005-03-01This return/report is a short plan year return/report (less than 12 months)No
2005-03-01Plan is a collectively bargained planNo
2005-03-01Plan funding arrangement – InsuranceYes
2005-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number487699
Policy instance 1
Insurance contract or identification number487699
Number of Individuals Covered170
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $8,709
Total amount of fees paid to insurance companyUSD $3,815
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $70,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,709
Amount paid for insurance broker fees3815
Insurance broker organization code?3
Insurance broker nameS.S. NESBITT AND COMPANY, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number487699
Policy instance 1
Insurance contract or identification number487699
Number of Individuals Covered164
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $8,468
Total amount of fees paid to insurance companyUSD $3,869
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 CarrierUSD $68,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,468
Amount paid for insurance broker fees3869
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameS.S. NESBITT AND COMPANY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number487699
Policy instance 1
Insurance contract or identification number487699
Number of Individuals Covered161
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $7,888
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?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 CarrierUSD $63,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,827
Insurance broker organization code?3
Insurance broker nameS.S. NESBITT AND COMPANY
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number487699
Policy instance 1
Insurance contract or identification number487699
Number of Individuals Covered159
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $7,504
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?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 CarrierUSD $60,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,504
Insurance broker organization code?3
Insurance broker nameSYNERGY ENROLLMENT PARTNERS INC.
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53355
Policy instance 1
Insurance contract or identification numberG53355
Number of Individuals Covered152
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $48,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53355
Policy instance 1
Insurance contract or identification numberG53355
Number of Individuals Covered149
Insurance policy start date2012-03-01
Insurance policy end date2012-04-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $8,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53355
Policy instance 1
Insurance contract or identification numberG53355
Number of Individuals Covered145
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
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?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $47,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53355
Policy instance 1
Insurance contract or identification numberG53355
Number of Individuals Covered142
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $4,390
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?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $66,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,813
Insurance broker organization code?3
Insurance broker nameROBERT HARRIS

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