401k Plan data: CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN plan

CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN 401k Plan overview

Plan Name	CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN
Plan identification number	501

CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CENTENNIAL ACADEMY has sponsored the creation of one or more 401k plans.

Company Name: CENTENNIAL ACADEMY

Employer identification number (EIN): 463320965

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-07-01 RENARTA FREEMAN 2020-01-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-07-01	RENARTA FREEMAN	2020-01-09

Plan Statistics for CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN

401k plan membership statisitcs for CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN

Measure Date Value
2018: CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 101
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 78
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 78
Number of employers contributing to the scheme 2018-07-01 0

Measure	Date	Value
2018: CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	101
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	78
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	78
Number of employers contributing to the scheme	2018-07-01	0

Form 5500 Responses for CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN

2018: CENTENNIAL PLACE ACADEMY, INC. WRAP PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	First time form 5500 has been submitted	Yes
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

908745

Policy instance

Insurance contract or identification number	908745
Number of Individuals Covered	180
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $39,081
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $742,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,081
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-43572

Policy instance

Insurance contract or identification number	010-43572
Number of Individuals Covered	193
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $5,592
Total amount of fees paid to insurance company	USD $2,072
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,592
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5359864

Policy instance

Insurance contract or identification number	5359864
Number of Individuals Covered	141
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $3,926
Total amount of fees paid to insurance company	USD $1,502
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $19,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,926
Amount paid for insurance broker fees	983
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

BKRC00505

Policy instance

Insurance contract or identification number	BKRC00505
Number of Individuals Covered	84
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,688
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $14,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $1,377
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10219704

Policy instance

Insurance contract or identification number	10219704
Number of Individuals Covered	104
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $5,846
Total amount of fees paid to insurance company	USD $6,563
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $38,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,846
Amount paid for insurance broker fees	1998
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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Company Name:	CENTENNIAL ACADEMY
Employer identification number (EIN):	463320965
NAIC Classification:	611000