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CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameCARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN
Plan identification number 001

CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

CARPETLAND U.S.A. OF DAVENPORT, INC has sponsored the creation of one or more 401k plans.

Company Name:CARPETLAND U.S.A. OF DAVENPORT, INC
Employer identification number (EIN):420982720
NAIC Classification:442210
NAIC Description:Floor Covering Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-03-01
0012022-03-01
0012021-03-01
0012020-02-29
0012019-03-01
0012019-03-01
0012018-03-01
0012017-03-01ERIC LANGAN
0012016-03-01ERIC D. LANGAN2017-09-07
0012015-03-01ERIC D. LANGAN2016-09-12
0012014-03-01ERIC D. LANGAN2015-09-08
0012013-03-01ERIC D. LANGAN2014-09-08
0012012-03-01ERIC D. LANGAN2013-08-07
0012011-03-01ERIC D. LANGAN2012-08-20
0012010-03-01ERIC D. LANGAN2011-09-28

Plan Statistics for CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2023: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year2023-03-0173
Total number of active participants reported on line 7a of the Form 55002023-03-0167
Number of retired or separated participants receiving benefits2023-03-011
Number of other retired or separated participants entitled to future benefits2023-03-012
Total of all active and inactive participants2023-03-0170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-03-010
Total participants2023-03-0170
Number of participants with account balances2023-03-0164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-03-013
2022: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year2022-03-0178
Total number of active participants reported on line 7a of the Form 55002022-03-0171
Number of retired or separated participants receiving benefits2022-03-010
Number of other retired or separated participants entitled to future benefits2022-03-012
Total of all active and inactive participants2022-03-0173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-03-010
Total participants2022-03-0173
Number of participants with account balances2022-03-0165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-03-012
2021: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-03-0174
Total number of active participants reported on line 7a of the Form 55002021-03-0172
Number of retired or separated participants receiving benefits2021-03-010
Number of other retired or separated participants entitled to future benefits2021-03-016
Total of all active and inactive participants2021-03-0178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-03-010
Total participants2021-03-0178
Number of participants with account balances2021-03-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-03-013
2020: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-2983
Total number of active participants reported on line 7a of the Form 55002020-02-2970
Number of retired or separated participants receiving benefits2020-02-290
Number of other retired or separated participants entitled to future benefits2020-02-294
Total of all active and inactive participants2020-02-2974
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-02-290
Total participants2020-02-2974
Number of participants with account balances2020-02-2964
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-02-292
2019: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-0184
Total number of active participants reported on line 7a of the Form 55002019-03-0178
Number of retired or separated participants receiving benefits2019-03-010
Number of other retired or separated participants entitled to future benefits2019-03-015
Total of all active and inactive participants2019-03-0183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-03-010
Total participants2019-03-0183
Number of participants with account balances2019-03-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-03-016
2018: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-0184
Total number of active participants reported on line 7a of the Form 55002018-03-0175
Number of retired or separated participants receiving benefits2018-03-011
Number of other retired or separated participants entitled to future benefits2018-03-018
Total of all active and inactive participants2018-03-0184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-03-010
Total participants2018-03-0184
Number of participants with account balances2018-03-0174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-03-011
2017: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-0189
Total number of active participants reported on line 7a of the Form 55002017-03-0178
Number of retired or separated participants receiving benefits2017-03-010
Number of other retired or separated participants entitled to future benefits2017-03-016
Total of all active and inactive participants2017-03-0184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-03-010
Total participants2017-03-0184
Number of participants with account balances2017-03-0164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-03-010

Financial Data on CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2024 : CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2024 401k financial data
Transfers to/from the plan2024-02-29$0
Total plan liabilities at end of year2024-02-29$2,985
Total plan liabilities at beginning of year2024-02-29$0
Total income from all sources2024-02-29$1,641,493
Expenses. Total of all expenses incurred2024-02-29$252,746
Benefits paid (including direct rollovers)2024-02-29$213,358
Total plan assets at end of year2024-02-29$8,145,031
Total plan assets at beginning of year2024-02-29$6,753,299
Value of fidelity bond covering the plan2024-02-29$500,000
Assets. Value of tangible personal property2024-02-29$0
Total contributions received or receivable from participants2024-02-29$369,239
Assets. Value of loans (other than to participants)2024-02-29$0
Expenses. Other expenses not covered elsewhere2024-02-29$0
Contributions received from other sources (not participants or employers)2024-02-29$0
Other income received2024-02-29$1,118,276
Noncash contributions received2024-02-29$0
Net income (gross income less expenses)2024-02-29$1,388,747
Net plan assets at end of year (total assets less liabilities)2024-02-29$8,142,046
Net plan assets at beginning of year (total assets less liabilities)2024-02-29$6,753,299
Assets. Value of participant loans2024-02-29$1,830
Assets. Value of assets in partnership/joint-venture interests2024-02-29$0
Assets. Value of real-estate (other than employer real property)2024-02-29$0
Assets. Value of employer securities2024-02-29$0
Assets. Value of employer real property2024-02-29$0
Total contributions received or receivable from employer(s)2024-02-29$153,978
Value of certain deemed distributions of participant loans2024-02-29$0
Value of corrective distributions2024-02-29$4,692
Expenses. Administrative service providers (salaries,fees and commissions)2024-02-29$34,696
2023 : CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2023 401k financial data
Transfers to/from the plan2023-02-28$0
Total plan liabilities at end of year2023-02-28$0
Total plan liabilities at beginning of year2023-02-28$3
Total income from all sources2023-02-28$107,899
Expenses. Total of all expenses incurred2023-02-28$645,728
Benefits paid (including direct rollovers)2023-02-28$603,923
Total plan assets at end of year2023-02-28$6,753,299
Total plan assets at beginning of year2023-02-28$7,291,131
Value of fidelity bond covering the plan2023-02-28$500,000
Assets. Value of tangible personal property2023-02-28$0
Total contributions received or receivable from participants2023-02-28$356,177
Assets. Value of loans (other than to participants)2023-02-28$0
Expenses. Other expenses not covered elsewhere2023-02-28$0
Contributions received from other sources (not participants or employers)2023-02-28$2,583
Other income received2023-02-28$-448,493
Noncash contributions received2023-02-28$0
Net income (gross income less expenses)2023-02-28$-537,829
Net plan assets at end of year (total assets less liabilities)2023-02-28$6,753,299
Net plan assets at beginning of year (total assets less liabilities)2023-02-28$7,291,128
Assets. Value of participant loans2023-02-28$0
Assets. Value of assets in partnership/joint-venture interests2023-02-28$0
Assets. Value of real-estate (other than employer real property)2023-02-28$0
Assets. Value of employer securities2023-02-28$0
Assets. Value of employer real property2023-02-28$0
Total contributions received or receivable from employer(s)2023-02-28$197,632
Value of certain deemed distributions of participant loans2023-02-28$0
Value of corrective distributions2023-02-28$7,941
Expenses. Administrative service providers (salaries,fees and commissions)2023-02-28$33,864
2022 : CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2022 401k financial data
Transfers to/from the plan2022-02-28$0
Total plan liabilities at end of year2022-02-28$3
Total plan liabilities at beginning of year2022-02-28$1
Total income from all sources2022-02-28$708,277
Expenses. Total of all expenses incurred2022-02-28$117,434
Benefits paid (including direct rollovers)2022-02-28$70,914
Total plan assets at end of year2022-02-28$7,291,131
Total plan assets at beginning of year2022-02-28$6,700,286
Value of fidelity bond covering the plan2022-02-28$500,000
Total contributions received or receivable from participants2022-02-28$359,703
Expenses. Other expenses not covered elsewhere2022-02-28$0
Contributions received from other sources (not participants or employers)2022-02-28$0
Other income received2022-02-28$196,650
Noncash contributions received2022-02-28$0
Net income (gross income less expenses)2022-02-28$590,843
Net plan assets at end of year (total assets less liabilities)2022-02-28$7,291,128
Net plan assets at beginning of year (total assets less liabilities)2022-02-28$6,700,285
Assets. Value of participant loans2022-02-28$9,025
Total contributions received or receivable from employer(s)2022-02-28$151,924
Value of certain deemed distributions of participant loans2022-02-28$0
Value of corrective distributions2022-02-28$12,389
Expenses. Administrative service providers (salaries,fees and commissions)2022-02-28$34,131
2021 : CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2021 401k financial data
Transfers to/from the plan2021-02-28$0
Total plan liabilities at end of year2021-02-28$1
Total plan liabilities at beginning of year2021-02-28$254
Total income from all sources2021-02-28$1,781,270
Expenses. Total of all expenses incurred2021-02-28$219,345
Benefits paid (including direct rollovers)2021-02-28$185,974
Total plan assets at end of year2021-02-28$6,700,286
Total plan assets at beginning of year2021-02-28$5,138,614
Value of fidelity bond covering the plan2021-02-28$500,000
Assets. Value of tangible personal property2021-02-28$0
Total contributions received or receivable from participants2021-02-28$292,734
Assets. Value of loans (other than to participants)2021-02-28$0
Expenses. Other expenses not covered elsewhere2021-02-28$0
Contributions received from other sources (not participants or employers)2021-02-28$0
Other income received2021-02-28$1,385,059
Noncash contributions received2021-02-28$0
Net income (gross income less expenses)2021-02-28$1,561,925
Net plan assets at end of year (total assets less liabilities)2021-02-28$6,700,285
Net plan assets at beginning of year (total assets less liabilities)2021-02-28$5,138,360
Assets. Value of participant loans2021-02-28$11,325
Assets. Value of assets in partnership/joint-venture interests2021-02-28$0
Assets. Value of real-estate (other than employer real property)2021-02-28$0
Assets. Value of employer securities2021-02-28$0
Assets. Value of employer real property2021-02-28$0
Total contributions received or receivable from employer(s)2021-02-28$103,477
Value of certain deemed distributions of participant loans2021-02-28$0
Value of corrective distributions2021-02-28$4,571
Expenses. Administrative service providers (salaries,fees and commissions)2021-02-28$28,800
2020 : CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2020 401k financial data
Transfers to/from the plan2020-02-28$0
Total plan liabilities at end of year2020-02-28$254
Total plan liabilities at beginning of year2020-02-28$1
Total income from all sources2020-02-28$668,554
Expenses. Total of all expenses incurred2020-02-28$888,775
Benefits paid (including direct rollovers)2020-02-28$855,264
Total plan assets at end of year2020-02-28$5,138,614
Total plan assets at beginning of year2020-02-28$5,358,582
Value of fidelity bond covering the plan2020-02-28$500,000
Total contributions received or receivable from participants2020-02-28$260,559
Expenses. Other expenses not covered elsewhere2020-02-28$0
Contributions received from other sources (not participants or employers)2020-02-28$40,419
Other income received2020-02-28$261,973
Noncash contributions received2020-02-28$0
Net income (gross income less expenses)2020-02-28$-220,221
Net plan assets at end of year (total assets less liabilities)2020-02-28$5,138,360
Net plan assets at beginning of year (total assets less liabilities)2020-02-28$5,358,581
Assets. Value of participant loans2020-02-28$14,932
Total contributions received or receivable from employer(s)2020-02-28$105,603
Value of certain deemed distributions of participant loans2020-02-28$0
Value of corrective distributions2020-02-28$5,898
Expenses. Administrative service providers (salaries,fees and commissions)2020-02-28$27,613
2019 : CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2019 401k financial data
Transfers to/from the plan2019-02-28$0
Total plan liabilities at end of year2019-02-28$1
Total plan liabilities at beginning of year2019-02-28$0
Total income from all sources2019-02-28$555,704
Expenses. Total of all expenses incurred2019-02-28$295,511
Benefits paid (including direct rollovers)2019-02-28$268,086
Total plan assets at end of year2019-02-28$5,358,582
Total plan assets at beginning of year2019-02-28$5,098,388
Value of fidelity bond covering the plan2019-02-28$500,000
Total contributions received or receivable from participants2019-02-28$243,133
Expenses. Other expenses not covered elsewhere2019-02-28$0
Contributions received from other sources (not participants or employers)2019-02-28$31,456
Other income received2019-02-28$172,625
Noncash contributions received2019-02-28$0
Net income (gross income less expenses)2019-02-28$260,193
Net plan assets at end of year (total assets less liabilities)2019-02-28$5,358,581
Net plan assets at beginning of year (total assets less liabilities)2019-02-28$5,098,388
Assets. Value of participant loans2019-02-28$14,870
Total contributions received or receivable from employer(s)2019-02-28$108,490
Value of certain deemed distributions of participant loans2019-02-28$0
Value of corrective distributions2019-02-28$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-02-28$27,425
2018 : CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2018 401k financial data
Transfers to/from the plan2018-02-28$0
Total plan liabilities at end of year2018-02-28$0
Total plan liabilities at beginning of year2018-02-28$0
Total income from all sources2018-02-28$980,407
Expenses. Total of all expenses incurred2018-02-28$118,980
Benefits paid (including direct rollovers)2018-02-28$92,151
Total plan assets at end of year2018-02-28$5,098,388
Total plan assets at beginning of year2018-02-28$4,236,961
Value of fidelity bond covering the plan2018-02-28$500,000
Total contributions received or receivable from participants2018-02-28$228,889
Expenses. Other expenses not covered elsewhere2018-02-28$0
Contributions received from other sources (not participants or employers)2018-02-28$0
Other income received2018-02-28$712,302
Noncash contributions received2018-02-28$0
Net income (gross income less expenses)2018-02-28$861,427
Net plan assets at end of year (total assets less liabilities)2018-02-28$5,098,388
Net plan assets at beginning of year (total assets less liabilities)2018-02-28$4,236,961
Assets. Value of participant loans2018-02-28$18,595
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022018-02-28$0
Total contributions received or receivable from employer(s)2018-02-28$39,216
Value of certain deemed distributions of participant loans2018-02-28$0
Value of corrective distributions2018-02-28$0
Expenses. Administrative service providers (salaries,fees and commissions)2018-02-28$26,829

Form 5500 Responses for CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN

2023: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2023 form 5500 responses
2023-03-01Type of plan entitySingle employer plan
2023-03-01Submission has been amendedYes
2023-03-01This submission is the final filingNo
2023-03-01This return/report is a short plan year return/report (less than 12 months)No
2023-03-01Plan is a collectively bargained planNo
2023-03-01Plan funding arrangement – InsuranceYes
2023-03-01Plan funding arrangement – TrustYes
2023-03-01Plan benefit arrangement – InsuranceYes
2023-03-01Plan benefit arrangement - TrustYes
2022: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01This submission is the final filingNo
2022-03-01Plan is a collectively bargained planNo
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan funding arrangement – TrustYes
2022-03-01Plan benefit arrangement – InsuranceYes
2022-03-01Plan benefit arrangement - TrustYes
2021: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01This submission is the final filingNo
2021-03-01Plan is a collectively bargained planNo
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan funding arrangement – TrustYes
2021-03-01Plan benefit arrangement – InsuranceYes
2021-03-01Plan benefit arrangement - TrustYes
2020: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-02-29Type of plan entitySingle employer plan
2020-02-29Submission has been amendedNo
2020-02-29This submission is the final filingNo
2020-02-29This return/report is a short plan year return/report (less than 12 months)No
2020-02-29Plan is a collectively bargained planNo
2020-02-29Plan funding arrangement – InsuranceYes
2020-02-29Plan funding arrangement – TrustYes
2020-02-29Plan benefit arrangement – InsuranceYes
2020-02-29Plan benefit arrangement - TrustYes
2019: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Submission has been amendedNo
2019-03-01This submission is the final filingNo
2019-03-01This return/report is a short plan year return/report (less than 12 months)No
2019-03-01Plan is a collectively bargained planNo
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan funding arrangement – TrustYes
2019-03-01Plan benefit arrangement – InsuranceYes
2019-03-01Plan benefit arrangement - TrustYes
2018: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Submission has been amendedNo
2018-03-01This submission is the final filingNo
2018-03-01This return/report is a short plan year return/report (less than 12 months)No
2018-03-01Plan is a collectively bargained planNo
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan funding arrangement – TrustYes
2018-03-01Plan benefit arrangement – InsuranceYes
2018-03-01Plan benefit arrangement - TrustYes
2017: CARPETLAND USA OF DAVENPORT, INC. 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Submission has been amendedNo
2017-03-01This submission is the final filingNo
2017-03-01This return/report is a short plan year return/report (less than 12 months)No
2017-03-01Plan is a collectively bargained planNo
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan funding arrangement – TrustYes
2017-03-01Plan benefit arrangement – InsuranceYes
2017-03-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number895100087
Policy instance 1
Insurance contract or identification number895100087
Number of Individuals Covered20
Insurance policy start date2023-03-01
Insurance policy end date2024-02-29
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number895100087
Policy instance 1
Insurance contract or identification number895100087
Number of Individuals Covered20
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number895100087
Policy instance 1
Insurance contract or identification number895100087
Number of Individuals Covered23
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number895100087
Policy instance 1
Insurance contract or identification number895100087
Number of Individuals Covered24
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number895100087
Policy instance 1
Insurance contract or identification number895100087
Number of Individuals Covered24
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
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?0
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?Yes
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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number895100087
Policy instance 1
Insurance contract or identification number895100087
Number of Individuals Covered24
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Are there contracts with allocated funds for individual policies?0
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?Yes
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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number895100087
Policy instance 1
Insurance contract or identification number895100087
Insurance policy start date2018-09-19
Insurance policy end date2018-09-19
Are there contracts with allocated funds for individual policies?0
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?Yes
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 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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker name
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberRM 81905 - 1
Policy instance 2
Insurance contract or identification numberRM 81905 - 1
Number of Individuals Covered0
Insurance policy start date2017-03-01
Insurance policy end date2017-11-15
Total amount of commissions paid to insurance brokerUSD $15,999
Are there contracts with allocated funds for individual policies?0
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
Commission paid to Insurance BrokerUSD $15,999
Amount paid for insurance broker fees0
Insurance broker organization code?4
Insurance broker nameTBS AGENCY INC

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