401k Plan data: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN plan

CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 401k Plan overview

Plan Name	CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN
Plan identification number	504

CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

CENTRAL NATIONAL - GOTTESMAN INC. has sponsored the creation of one or more 401k plans.

Company Name: CENTRAL NATIONAL - GOTTESMAN INC.

Employer identification number (EIN): 130425246

NAIC Classification: 424100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2014-06-01 STEVEN M EIGEN CENTRAL NATIONAL GOTTESMAN 2017-01-27
504 2014-06-01 STEVEN M. EIGEN
504 2013-06-01 STEVEN EIGEN STEVEN EIGEN 2014-12-12
504 2012-06-01 STEVEN M. EIGEN
504 2011-06-01 PETER C. SIEGFREID, SVP STEVEN M. EIGEN, CFO 2012-09-28
504 2010-06-01 STEVEN M. EIGEN, CFO
504 2009-06-01 STEVEN M. EIGEN

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2014-06-01	STEVEN M EIGEN	CENTRAL NATIONAL GOTTESMAN	2017-01-27
504	2014-06-01	STEVEN M. EIGEN
504	2013-06-01	STEVEN EIGEN	STEVEN EIGEN	2014-12-12
504	2012-06-01	STEVEN M. EIGEN
504	2011-06-01	PETER C. SIEGFREID, SVP	STEVEN M. EIGEN, CFO	2012-09-28
504	2010-06-01	STEVEN M. EIGEN, CFO
504	2009-06-01	STEVEN M. EIGEN

Plan Statistics for CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN

401k plan membership statisitcs for CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN

Measure Date Value
2014: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 553
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 0
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 0
2013: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 464
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 553
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 553
2012: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 471
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 464
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 464
2011: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 449
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 471
Number of retired or separated participants receiving benefits 2011-06-01 0
Number of other retired or separated participants entitled to future benefits 2011-06-01 0
Total of all active and inactive participants 2011-06-01 471
2010: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-06-01 420
Total number of active participants reported on line 7a of the Form 5500 2010-06-01 449
Number of retired or separated participants receiving benefits 2010-06-01 0
Number of other retired or separated participants entitled to future benefits 2010-06-01 0
Total of all active and inactive participants 2010-06-01 449
2009: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 461
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 420
Number of retired or separated participants receiving benefits 2009-06-01 0
Number of other retired or separated participants entitled to future benefits 2009-06-01 0
Total of all active and inactive participants 2009-06-01 420

Measure	Date	Value
2014: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	553
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	0
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	0
2013: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	464
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	553
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	553
2012: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	471
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	464
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	464
2011: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	449
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	471
Number of retired or separated participants receiving benefits	2011-06-01	0
Number of other retired or separated participants entitled to future benefits	2011-06-01	0
Total of all active and inactive participants	2011-06-01	471
2010: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-06-01	420
Total number of active participants reported on line 7a of the Form 5500	2010-06-01	449
Number of retired or separated participants receiving benefits	2010-06-01	0
Number of other retired or separated participants entitled to future benefits	2010-06-01	0
Total of all active and inactive participants	2010-06-01	449
2009: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	461
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	420
Number of retired or separated participants receiving benefits	2009-06-01	0
Number of other retired or separated participants entitled to future benefits	2009-06-01	0
Total of all active and inactive participants	2009-06-01	420

Form 5500 Responses for CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN

2014: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	Yes
2014-06-01	This submission is the final filing	Yes
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Submission has been amended	No
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Submission has been amended	No
2011-06-01	This submission is the final filing	No
2011-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-06-01	Plan is a collectively bargained plan	No
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2010: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2010 form 5500 responses
2010-06-01	Type of plan entity	Single employer plan
2010-06-01	Submission has been amended	Yes
2010-06-01	This submission is the final filing	No
2010-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-06-01	Plan is a collectively bargained plan	No
2010-06-01	Plan funding arrangement – Insurance	Yes
2010-06-01	Plan benefit arrangement – Insurance	Yes
2009: CENTRAL NATIONAL - GOTTESMAN GROUP LONG TERM DISABILITY PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Submission has been amended	No
2009-06-01	This submission is the final filing	No
2009-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-06-01	Plan is a collectively bargained plan	No
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

040475

Policy instance

Insurance contract or identification number	040475
Number of Individuals Covered	552
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,608
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $361,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4608
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CORPORATE SYNERGIES GROUP, LLC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

040475

Policy instance

Insurance contract or identification number	040475
Number of Individuals Covered	553
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,021
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $331,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3021
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CORPORATE SYNERGIES GROUP, LLC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

040475

Policy instance

Insurance contract or identification number	040475
Number of Individuals Covered	464
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,146
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $378,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5146
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CORPORATE SYNERGIES GROUP, LLC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

040475

Policy instance

Insurance contract or identification number	040475
Number of Individuals Covered	471
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $1,332
Total amount of fees paid to insurance company	USD $3,647
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $317,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

040475

Policy instance

Insurance contract or identification number	040475
Number of Individuals Covered	478
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $7,841
Total amount of fees paid to insurance company	USD $3,229
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $314,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CENTRAL NATIONAL - GOTTESMAN INC.
Employer identification number (EIN):	130425246
NAIC Classification:	424100