401k Plan data: AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN plan

AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN 401k Plan overview

Plan Name	AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN
Plan identification number	001

AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

AFFIRMATIVE INSURANCE HOLDINGS, INC has sponsored the creation of one or more 401k plans.

Company Name: AFFIRMATIVE INSURANCE HOLDINGS, INC

Employer identification number (EIN): 752770432

NAIC Classification: 524290

Additional information about AFFIRMATIVE INSURANCE HOLDINGS, INC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 2913512

More information about AFFIRMATIVE INSURANCE HOLDINGS, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 DON BESKRONE, ESQ., CHAPTER 7 TTEE DON BESKRONE, ESQ., CHAPTER 7 TTEE 2017-08-11
001 2015-01-01 DON BESKRONE, ESQ., CHAPTER 7 TTEE DON BESKRONE, ESQ., CHAPTER 7 TTEE 2016-10-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	DON BESKRONE, ESQ., CHAPTER 7 TTEE		DON BESKRONE, ESQ., CHAPTER 7 TTEE	2017-08-11
001	2015-01-01	DON BESKRONE, ESQ., CHAPTER 7 TTEE		DON BESKRONE, ESQ., CHAPTER 7 TTEE	2016-10-06

Plan Statistics for AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN

401k plan membership statisitcs for AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN

Measure Date Value
2016: AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 335
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 753
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 20
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 311
Total of all active and inactive participants 2015-01-01 334
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 335
Number of participants with account balances 2015-01-01 332
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0

Measure	Date	Value
2016: AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	335
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	753
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	20
Number of retired or separated participants receiving benefits	2015-01-01	3
Number of other retired or separated participants entitled to future benefits	2015-01-01	311
Total of all active and inactive participants	2015-01-01	334
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	335
Number of participants with account balances	2015-01-01	332
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0

Financial Data on AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN

Measure	Date	Value
2016 : AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-10-18	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-10-18	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-10-18	$0
Total income from all sources (including contributions)	2016-10-18	$-319,145
Total loss/gain on sale of assets	2016-10-18	$0
Total of all expenses incurred	2016-10-18	$13,689,667
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-10-18	$13,625,586
Expenses. Certain deemed distributions of participant loans	2016-10-18	$0
Value of total corrective distributions	2016-10-18	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-10-18	$5,467
Value of total assets at end of year	2016-10-18	$0
Value of total assets at beginning of year	2016-10-18	$14,008,812
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-10-18	$64,081
Total interest from all sources	2016-10-18	$-106,580
Total dividends received (eg from common stock, registered investment company shares)	2016-10-18	$16,015
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-10-18	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-10-18	$0
Total dividends received from registered investment company shares (eg mutual funds)	2016-10-18	$16,015
Administrative expenses professional fees incurred	2016-10-18	$50,500
Was this plan covered by a fidelity bond	2016-10-18	No
If this is an individual account plan, was there a blackout period	2016-10-18	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-10-18	$0
Contributions received from participants	2016-10-18	$4,558
Participant contributions at end of year	2016-10-18	$0
Participant contributions at beginning of year	2016-10-18	$72,978
Assets. Other investments not covered elsewhere at end of year	2016-10-18	$0
Assets. Other investments not covered elsewhere at beginning of year	2016-10-18	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-10-18	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-10-18	$11,361,262
Other income not declared elsewhere	2016-10-18	$0
Administrative expenses (other) incurred	2016-10-18	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-10-18	No
Value of net income/loss	2016-10-18	$-14,008,812
Value of net assets at end of year (total assets less liabilities)	2016-10-18	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-10-18	$14,008,812
Were any loans by the plan or fixed income obligations due to the plan in default	2016-10-18	No
Were any leases to which the plan was party in default or uncollectible	2016-10-18	No
Investment advisory and management fees	2016-10-18	$1,319
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-10-18	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-10-18	$11,451,955
Value of interest in pooled separate accounts at end of year	2016-10-18	$0
Value of interest in pooled separate accounts at beginning of year	2016-10-18	$0
Interest on participant loans	2016-10-18	$960
Interest earned on other investments	2016-10-18	$-107,540
Value of interest in common/collective trusts at end of year	2016-10-18	$0
Value of interest in common/collective trusts at beginning of year	2016-10-18	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-10-18	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-10-18	$2,483,879
Expenses. Payments to insurance carriers foe the provision of benefits	2016-10-18	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-10-18	$-234,047
Net investment gain/loss from pooled separate accounts	2016-10-18	$0
Net investment gain or loss from common/collective trusts	2016-10-18	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-10-18	Yes
Was there a failure to transmit to the plan any participant contributions	2016-10-18	Yes
Has the plan failed to provide any benefit when due under the plan	2016-10-18	No
Assets. Invements in employer securities at end of year	2016-10-18	$0
Assets. Invements in employer securities at beginning of year	2016-10-18	$0
Contributions received in cash from employer	2016-10-18	$909
Income. Dividends from common stock	2016-10-18	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-10-18	$2,264,324
Contract administrator fees	2016-10-18	$12,262
Did the plan have assets held for investment	2016-10-18	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-10-18	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-10-18	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-10-18	Yes
Opinion of an independent qualified public accountant for this plan	2016-10-18	Disclaimer
Accountancy firm name	2016-10-18	BEDERSON LLP
Accountancy firm EIN	2016-10-18	222978848
2015 : AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$1,934,857
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$6,733,960
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$6,698,240
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,765,106
Value of total assets at end of year	2015-12-31	$14,008,812
Value of total assets at beginning of year	2015-12-31	$18,807,915
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$35,720
Total interest from all sources	2015-12-31	$43,943
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$822,849
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$822,849
Administrative expenses professional fees incurred	2015-12-31	$8,114
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$1,033,651
Participant contributions at end of year	2015-12-31	$72,978
Participant contributions at beginning of year	2015-12-31	$387,592
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$104,956
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$1,196
Administrative expenses (other) incurred	2015-12-31	$250
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-4,799,103
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$14,008,812
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$18,807,915
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$6,196
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$11,451,955
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$12,548,436
Interest on participant loans	2015-12-31	$13,577
Interest earned on other investments	2015-12-31	$30,366
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$2,483,879
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$5,871,887
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-698,237
Net investment gain/loss from pooled separate accounts	2015-12-31	$0
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at end of year	2015-12-31	$0
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$626,499
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$6,698,240
Contract administrator fees	2015-12-31	$21,160
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	BEDERSON LLP
Accountancy firm EIN	2015-12-31	222978848

Form 5500 Responses for AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) PLAN

2016: AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: AFFIRMATIVE INSURANCE HOLDINGS, INC. 401(K) 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 – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	AFFIRMATIVE INSURANCE HOLDINGS, INC
Employer identification number (EIN):	752770432
NAIC Classification:	524290

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	2913512