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NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 401k Plan overview

Plan NameNORTH CAROLINA OFS RETIREMENT PLAN & TRUST
Plan identification number 001

NORTH CAROLINA OFS RETIREMENT PLAN & TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • 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 covering Self-Employed individuals.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

COLEMAN AND COLEMAN PARTNERSHIP has sponsored the creation of one or more 401k plans.

Company Name:COLEMAN AND COLEMAN PARTNERSHIP
Employer identification number (EIN):205377239
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH CAROLINA OFS RETIREMENT PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01
0012022-01-01
0012021-01-01
0012020-01-01
0012020-01-01
0012019-01-01
0012018-01-01MICHAEL J. COLEMAN, DDS2019-10-14
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01PATRICK J. COLEMAN, D.M.D.
0012013-01-01PATRICK J. COLEMAN, D.M.D.
0012012-01-01PATRICK J. COLEMAN, D.M.D.
0012011-01-01PATRICK J. COLEMAN, D.M.D.
0012009-01-01J. PATRICK COLEMAN, D.D.S. J. PATRICK COLEMAN, D.D.S.2010-10-07

Plan Statistics for NORTH CAROLINA OFS RETIREMENT PLAN & TRUST

401k plan membership statisitcs for NORTH CAROLINA OFS RETIREMENT PLAN & TRUST

Measure Date Value
2019: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-0118
Total number of active participants reported on line 7a of the Form 55002019-01-0114
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-013
Total of all active and inactive participants2019-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0119
Number of participants with account balances2019-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2017: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-0119
Total number of active participants reported on line 7a of the Form 55002017-01-0113
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-014
Total of all active and inactive participants2017-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0118
Number of participants with account balances2017-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-011
2016: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-0115
Total number of active participants reported on line 7a of the Form 55002016-01-0112
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-015
Total of all active and inactive participants2016-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0117
Number of participants with account balances2016-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-011
2015: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-0114
Total number of active participants reported on line 7a of the Form 55002015-01-0113
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-012
Total of all active and inactive participants2015-01-0115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0115
Number of participants with account balances2015-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0112
Total number of active participants reported on line 7a of the Form 55002014-01-0110
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-013
Total of all active and inactive participants2014-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0113
Number of participants with account balances2014-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
2013: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0110
Total number of active participants reported on line 7a of the Form 55002013-01-0111
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0112
Number of participants with account balances2013-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-019
Total number of active participants reported on line 7a of the Form 55002012-01-018
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-019
Number of participants with account balances2012-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0110
Total number of active participants reported on line 7a of the Form 55002011-01-016
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-017
Number of participants with account balances2011-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0113
Total number of active participants reported on line 7a of the Form 55002009-01-017
Number of retired or separated participants receiving benefits2009-01-011
Number of other retired or separated participants entitled to future benefits2009-01-014
Total of all active and inactive participants2009-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0112
Number of participants with account balances2009-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on NORTH CAROLINA OFS RETIREMENT PLAN & TRUST

Measure Date Value
2019 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2019 401k financial data
Total plan liabilities at end of year2019-12-31$338
Total plan liabilities at beginning of year2019-12-31$338
Total income from all sources2019-12-31$565,739
Expenses. Total of all expenses incurred2019-12-31$11,908
Benefits paid (including direct rollovers)2019-12-31$2,371
Total plan assets at end of year2019-12-31$2,092,680
Total plan assets at beginning of year2019-12-31$1,538,849
Value of fidelity bond covering the plan2019-12-31$250,000
Total contributions received or receivable from participants2019-12-31$91,606
Expenses. Other expenses not covered elsewhere2019-12-31$0
Contributions received from other sources (not participants or employers)2019-12-31$17,640
Other income received2019-12-31$360,550
Noncash contributions received2019-12-31$0
Net income (gross income less expenses)2019-12-31$553,831
Net plan assets at end of year (total assets less liabilities)2019-12-31$2,092,342
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$1,538,511
Assets. Value of employer securities2019-12-31$355,000
Total contributions received or receivable from employer(s)2019-12-31$95,943
Value of certain deemed distributions of participant loans2019-12-31$0
Value of corrective distributions2019-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$9,537
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2017 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2017 401k financial data
Total income from all sources2017-12-31$325,484
Expenses. Total of all expenses incurred2017-12-31$142,993
Benefits paid (including direct rollovers)2017-12-31$44,820
Total plan assets at end of year2017-12-31$1,531,862
Total plan assets at beginning of year2017-12-31$1,349,371
Value of fidelity bond covering the plan2017-12-31$250,000
Total contributions received or receivable from participants2017-12-31$88,272
Expenses. Other expenses not covered elsewhere2017-12-31$90,000
Other income received2017-12-31$169,122
Net income (gross income less expenses)2017-12-31$182,491
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,531,862
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,349,371
Assets. Value of assets in partnership/joint-venture interests2017-12-31$0
Total contributions received or receivable from employer(s)2017-12-31$68,090
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$8,173
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2016 401k financial data
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$326,208
Expenses. Total of all expenses incurred2016-12-31$149,502
Benefits paid (including direct rollovers)2016-12-31$50,000
Total plan assets at end of year2016-12-31$1,349,371
Total plan assets at beginning of year2016-12-31$1,172,665
Value of fidelity bond covering the plan2016-12-31$250,000
Total contributions received or receivable from participants2016-12-31$62,801
Expenses. Other expenses not covered elsewhere2016-12-31$90,000
Contributions received from other sources (not participants or employers)2016-12-31$6,433
Other income received2016-12-31$158,690
Net income (gross income less expenses)2016-12-31$176,706
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,349,371
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,172,665
Assets. Value of assets in partnership/joint-venture interests2016-12-31$872
Total contributions received or receivable from employer(s)2016-12-31$98,284
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$9,502
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$212,548
Expenses. Total of all expenses incurred2015-12-31$104,947
Benefits paid (including direct rollovers)2015-12-31$4,597
Total plan assets at end of year2015-12-31$1,172,665
Total plan assets at beginning of year2015-12-31$1,065,064
Value of fidelity bond covering the plan2015-12-31$250,000
Total contributions received or receivable from participants2015-12-31$88,342
Expenses. Other expenses not covered elsewhere2015-12-31$90,000
Contributions received from other sources (not participants or employers)2015-12-31$70,283
Other income received2015-12-31$-34,675
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$107,601
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,172,665
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,065,064
Assets. Value of assets in partnership/joint-venture interests2015-12-31$19,802
Total contributions received or receivable from employer(s)2015-12-31$88,598
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$10,350
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2014 401k financial data
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$161,988
Expenses. Total of all expenses incurred2014-12-31$99,148
Benefits paid (including direct rollovers)2014-12-31$0
Total plan assets at end of year2014-12-31$1,065,064
Total plan assets at beginning of year2014-12-31$1,002,224
Value of fidelity bond covering the plan2014-12-31$250,000
Total contributions received or receivable from participants2014-12-31$65,242
Expenses. Other expenses not covered elsewhere2014-12-31$90,000
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$20,880
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$62,840
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,065,064
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,002,224
Assets. Value of assets in partnership/joint-venture interests2014-12-31$70,917
Total contributions received or receivable from employer(s)2014-12-31$75,866
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$9,148
2013 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2013 401k financial data
Total income from all sources2013-12-31$196,262
Expenses. Total of all expenses incurred2013-12-31$7,568
Total plan assets at end of year2013-12-31$1,002,224
Total plan assets at beginning of year2013-12-31$813,530
Value of fidelity bond covering the plan2013-12-31$250,000
Total contributions received or receivable from participants2013-12-31$58,242
Other income received2013-12-31$89,297
Net income (gross income less expenses)2013-12-31$188,694
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,002,224
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$813,530
Assets. Value of assets in partnership/joint-venture interests2013-12-31$86,241
Total contributions received or receivable from employer(s)2013-12-31$48,723
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$7,568
2012 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$147,915
Expenses. Total of all expenses incurred2012-12-31$6,096
Total plan assets at end of year2012-12-31$813,530
Total plan assets at beginning of year2012-12-31$671,711
Value of fidelity bond covering the plan2012-12-31$250,000
Total contributions received or receivable from participants2012-12-31$46,242
Other income received2012-12-31$69,489
Net income (gross income less expenses)2012-12-31$141,819
Net plan assets at end of year (total assets less liabilities)2012-12-31$813,530
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$671,711
Assets. Value of assets in partnership/joint-venture interests2012-12-31$88,661
Total contributions received or receivable from employer(s)2012-12-31$32,184
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$6,096
2011 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2011 401k financial data
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$92,453
Expenses. Total of all expenses incurred2011-12-31$85,680
Benefits paid (including direct rollovers)2011-12-31$79,778
Total plan assets at end of year2011-12-31$671,711
Total plan assets at beginning of year2011-12-31$664,938
Value of fidelity bond covering the plan2011-12-31$250,000
Total contributions received or receivable from participants2011-12-31$45,742
Noncash contributions received2011-12-31$5,064
Net income (gross income less expenses)2011-12-31$6,773
Net plan assets at end of year (total assets less liabilities)2011-12-31$671,711
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$664,938
Assets. Value of assets in partnership/joint-venture interests2011-12-31$87,495
Total contributions received or receivable from employer(s)2011-12-31$41,647
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$5,902
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2010 401k financial data
Total plan liabilities at end of year2010-12-31$308
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$140,325
Expenses. Total of all expenses incurred2010-12-31$149,500
Benefits paid (including direct rollovers)2010-12-31$144,180
Total plan assets at end of year2010-12-31$664,938
Total plan assets at beginning of year2010-12-31$673,805
Value of fidelity bond covering the plan2010-12-31$250,000
Total contributions received or receivable from participants2010-12-31$45,809
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$49,141
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$-9,175
Net plan assets at end of year (total assets less liabilities)2010-12-31$664,630
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$673,805
Assets. Value of assets in partnership/joint-venture interests2010-12-31$86,094
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022010-12-31$5,479
Total contributions received or receivable from employer(s)2010-12-31$45,375
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$5,320
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for NORTH CAROLINA OFS RETIREMENT PLAN & TRUST

2019: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2017: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 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 filingNo
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 – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 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 – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
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 – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: NORTH CAROLINA OFS RETIREMENT PLAN & TRUST 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 – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GUARDIAN LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number94007012
Policy instance 1
Insurance contract or identification number94007012
Number of Individuals Covered1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?1
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 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
Insurance broker organization code?3

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