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MAIDENFORM, INC. RETIREMENT PLAN 401k Plan overview

Plan NameMAIDENFORM, INC. RETIREMENT PLAN
Plan identification number 009

MAIDENFORM, INC. RETIREMENT PLAN Benefits

401k Plan TypeDefined Benefit Pension
Plan Features/Benefits
  • Benefits are primarily pay related
  • Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
  • Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).

401k Sponsoring company profile

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

Company Name:MAIDENFORM, INC.
Employer identification number (EIN):660201882
NAIC Classification:424300

Additional information about MAIDENFORM, INC.

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division
Incorporation Date: 1991-07-23
Company Identification Number: 62301
Legal Registered Office Address: 100 NORTH MAIN STREET
SUITE 2
BARRE
United States of America (USA)
05641

More information about MAIDENFORM, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAIDENFORM, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0092013-01-01SETH BOYARSKY SCOTT LEWIS2014-10-13
0092012-01-01SETH BOYARSKY JOHN NELSON2013-10-15
0092012-01-01SETH BOYARSKY JOHN NELSON2013-10-25
0092011-01-01SETH BOYARSKY JOHN NELSON2012-10-16
0092009-01-01ADELE STAVISH JOHN NELSON2010-10-14

Plan Statistics for MAIDENFORM, INC. RETIREMENT PLAN

401k plan membership statisitcs for MAIDENFORM, INC. RETIREMENT PLAN

Measure Date Value
2013: MAIDENFORM, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,407
Total of all active and inactive participants2013-01-010
Total participants2013-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: MAIDENFORM, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,420
Total number of active participants reported on line 7a of the Form 55002012-01-01248
Number of retired or separated participants receiving benefits2012-01-01408
Number of other retired or separated participants entitled to future benefits2012-01-01737
Total of all active and inactive participants2012-01-011,393
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-0114
Total participants2012-01-011,407
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: MAIDENFORM, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,433
Total number of active participants reported on line 7a of the Form 55002011-01-01286
Number of retired or separated participants receiving benefits2011-01-01393
Number of other retired or separated participants entitled to future benefits2011-01-01728
Total of all active and inactive participants2011-01-011,407
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-0113
Total participants2011-01-011,420
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-013
2009: MAIDENFORM, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,471
Total number of active participants reported on line 7a of the Form 55002009-01-01367
Number of retired or separated participants receiving benefits2009-01-01358
Number of other retired or separated participants entitled to future benefits2009-01-01712
Total of all active and inactive participants2009-01-011,437
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-0115
Total participants2009-01-011,452
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-0110

Financial Data on MAIDENFORM, INC. RETIREMENT PLAN

Measure Date Value
2013 : MAIDENFORM, INC. RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total transfer of assets from this plan2013-12-31$24,214,320
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$4,742,655
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$1,133,021
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,080,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$744,527
Value of total assets at end of year2013-12-31$0
Value of total assets at beginning of year2013-12-31$20,604,686
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$52,095
Total interest from all sources2013-12-31$13
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2013-12-31$0
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$47,679
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-12-31$107,397
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$1
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$3,609,634
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$20,604,686
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in pooled separate accounts at beginning of year2013-12-31$19,699,557
Income. Interest from US Government securities2013-12-31$13
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$179
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$179
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$0
Asset value of US Government securities at beginning of year2013-12-31$157
Net investment gain/loss from pooled separate accounts2013-12-31$3,998,115
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$696,848
Employer contributions (assets) at beginning of year2013-12-31$904,792
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$973,529
Contract administrator fees2013-12-31$52,095
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31BDO USA LLP
Accountancy firm EIN2013-12-31135381590
2012 : MAIDENFORM, INC. RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$3,222,930
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$961,926
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$961,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,267,168
Value of total assets at end of year2012-12-31$20,604,686
Value of total assets at beginning of year2012-12-31$18,343,682
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$0
Total interest from all sources2012-12-31$17
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-12-31$112,394
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$1
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$2
Total non interest bearing cash at end of year2012-12-31$904,792
Total non interest bearing cash at beginning of year2012-12-31$315,507
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$2,261,004
Value of net assets at end of year (total assets less liabilities)2012-12-31$20,604,686
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$18,343,682
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in pooled separate accounts at end of year2012-12-31$19,699,557
Value of interest in pooled separate accounts at beginning of year2012-12-31$18,027,855
Income. Interest from US Government securities2012-12-31$17
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$179
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$116
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$116
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$0
Asset value of US Government securities at end of year2012-12-31$157
Asset value of US Government securities at beginning of year2012-12-31$202
Net investment gain/loss from pooled separate accounts2012-12-31$1,955,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$1,267,168
Employer contributions (assets) at end of year2012-12-31$904,792
Employer contributions (assets) at beginning of year2012-12-31$315,507
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$849,532
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31BDO USA LLP
Accountancy firm EIN2012-12-31135381590
2011 : MAIDENFORM, INC. RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$787,795
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$839,574
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$839,574
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$744,768
Value of total assets at end of year2011-12-31$18,343,682
Value of total assets at beginning of year2011-12-31$18,395,461
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$0
Total interest from all sources2011-12-31$22
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$74,457
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$2
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$2
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-51,779
Value of net assets at end of year (total assets less liabilities)2011-12-31$18,343,682
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$18,395,461
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in pooled separate accounts at end of year2011-12-31$18,027,855
Value of interest in pooled separate accounts at beginning of year2011-12-31$17,822,824
Income. Interest from US Government securities2011-12-31$22
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$116
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$53
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$53
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$0
Asset value of US Government securities at end of year2011-12-31$202
Asset value of US Government securities at beginning of year2011-12-31$244
Net investment gain/loss from pooled separate accounts2011-12-31$43,005
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$744,768
Employer contributions (assets) at end of year2011-12-31$315,507
Employer contributions (assets) at beginning of year2011-12-31$572,338
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$765,117
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$41
Aggregate carrying amount (costs) on sale of assets2011-12-31$41
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31BDO USA, LLP
Accountancy firm EIN2011-12-31135381590
2010 : MAIDENFORM, INC. RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$-4,226
Total unrealized appreciation/depreciation of assets2010-12-31$-4,226
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$2,601,033
Total loss/gain on sale of assets2010-12-31$3,104
Total of all expenses incurred2010-12-31$768,757
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$768,757
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$633,352
Value of total assets at end of year2010-12-31$18,395,461
Value of total assets at beginning of year2010-12-31$16,563,185
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$0
Total interest from all sources2010-12-31$116
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$81,600
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$2
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$53
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$1,832,276
Value of net assets at end of year (total assets less liabilities)2010-12-31$18,395,461
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$16,563,185
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in pooled separate accounts at end of year2010-12-31$17,822,824
Value of interest in pooled separate accounts at beginning of year2010-12-31$16,547,082
Income. Interest from US Government securities2010-12-31$116
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$53
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$6,349
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$6,349
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$0
Asset value of US Government securities at end of year2010-12-31$244
Asset value of US Government securities at beginning of year2010-12-31$9,701
Net investment gain/loss from pooled separate accounts2010-12-31$1,968,687
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$633,352
Employer contributions (assets) at end of year2010-12-31$572,338
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$687,157
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$23,134
Aggregate carrying amount (costs) on sale of assets2010-12-31$20,030
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31SALIBELLO AND BRODER LLP
Accountancy firm EIN2010-12-31133051814

Form 5500 Responses for MAIDENFORM, INC. RETIREMENT PLAN

2013: MAIDENFORM, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingYes
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: MAIDENFORM, INC. RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: MAIDENFORM, INC. RETIREMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: MAIDENFORM, INC. RETIREMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberSA 12694
Policy instance 1
Insurance contract or identification numberSA 12694
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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?Yes
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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberSA 12694
Policy instance 1
Insurance contract or identification numberSA 12694
Number of Individuals Covered1407
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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?Yes
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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberSA 12694
Policy instance 1
Insurance contract or identification numberSA 12694
Number of Individuals Covered1420
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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?Yes
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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberSA 12694
Policy instance 1
Insurance contract or identification numberSA 12694
Number of Individuals Covered1433
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?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?Yes
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

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