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CAP CARPET, INC. LIFE INSURANCE PLAN 401k Plan overview

Plan NameCAP CARPET, INC. LIFE INSURANCE PLAN
Plan identification number 502

CAP CARPET, INC. LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CAP CARPET, INC. has sponsored the creation of one or more 401k plans.

Company Name:CAP CARPET, INC.
Employer identification number (EIN):480758150
NAIC Classification:442210
NAIC Description:Floor Covering Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAP CARPET, INC. LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022016-06-01RICHARD J. BLOOMER
5022015-06-01RICHARD J. BLOOMER
5022014-06-01RICHARD BLOOMER RICHARD BLOOMER2015-08-31
5022013-06-01RICK BLOOMER RICK BLOOMER2014-12-17
5022012-06-01RICHARD BLOOMER RICHARD BLOOMER2013-09-30
5022011-06-01RICHARD BLOOMER RICHARD BLOOMER2012-10-08
5022009-06-01RICHARD J. BLOOMER RICHARD J. BLOOMER2010-07-21

Plan Statistics for CAP CARPET, INC. LIFE INSURANCE PLAN

401k plan membership statisitcs for CAP CARPET, INC. LIFE INSURANCE PLAN

Measure Date Value
2016: CAP CARPET, INC. LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01162
Total number of active participants reported on line 7a of the Form 55002016-06-01146
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01146
2015: CAP CARPET, INC. LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01177
Total number of active participants reported on line 7a of the Form 55002015-06-01162
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01162
2014: CAP CARPET, INC. LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01152
Number of retired or separated participants receiving benefits2014-06-01177
Total of all active and inactive participants2014-06-01177
2013: CAP CARPET, INC. LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01152
Total number of active participants reported on line 7a of the Form 55002013-06-01152
Total of all active and inactive participants2013-06-01152
2012: CAP CARPET, INC. LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01155
Total number of active participants reported on line 7a of the Form 55002012-06-01155
Total of all active and inactive participants2012-06-01155
2011: CAP CARPET, INC. LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01151
Total number of active participants reported on line 7a of the Form 55002011-06-01151
Total of all active and inactive participants2011-06-01151
2009: CAP CARPET, INC. LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01143
Total number of active participants reported on line 7a of the Form 55002009-06-01143
Total of all active and inactive participants2009-06-01143
Total participants2009-06-010

Form 5500 Responses for CAP CARPET, INC. LIFE INSURANCE PLAN

2016: CAP CARPET, INC. LIFE INSURANCE PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01This submission is the final filingYes
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: CAP CARPET, INC. LIFE INSURANCE PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: CAP CARPET, INC. LIFE INSURANCE PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: CAP CARPET, INC. LIFE INSURANCE PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: CAP CARPET, INC. LIFE INSURANCE PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: CAP CARPET, INC. LIFE INSURANCE PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2009: CAP CARPET, INC. LIFE INSURANCE PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number240861
Policy instance 1
Insurance contract or identification number240861
Number of Individuals Covered162
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $6,690
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $66,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,690
Insurance broker organization code?3
Insurance broker nameRIDGE CONSULTING GROUP, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010176230
Policy instance 1
Insurance contract or identification number000010176230
Number of Individuals Covered177
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $9,089
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $7,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,089
Insurance broker organization code?3
Insurance broker nameRIDGE CONSULTING GROUP INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010176230
Policy instance 1
Insurance contract or identification number000010176230
Number of Individuals Covered152
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $723
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $5,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $723
Insurance broker organization code?3
Insurance broker nameRIDGE CONSULTING GROUP INC
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00007613
Policy instance 1
Insurance contract or identification number00007613
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00007613
Policy instance 1
Insurance contract or identification number00007613
Number of Individuals Covered151
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00007613
Policy instance 1
Insurance contract or identification number00007613
Number of Individuals Covered141
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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