401k Plan data: CENTURY III, INC. ANCILLARY PLAN plan

CENTURY III, INC. ANCILLARY PLAN 401k Plan overview

Plan Name	CENTURY III, INC. ANCILLARY PLAN
Plan identification number	502

CENTURY III, INC. ANCILLARY 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) Other welfare benefit cover

401k Sponsoring company profile

CENTURY III, INC. has sponsored the creation of one or more 401k plans.

Company Name: CENTURY III, INC.

Employer identification number (EIN): 570650616

NAIC Classification: 541600

Additional information about CENTURY III, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2008-08-18

Company Identification Number: P08000076786

Legal Registered Office Address: 8096 vistaview place

Frisco

75034

More information about CENTURY III, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTURY III, INC. ANCILLARY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-05-01 REBECCA ROVNER 2023-09-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2022-05-01	REBECCA ROVNER	2023-09-19

Plan Statistics for CENTURY III, INC. ANCILLARY PLAN

401k plan membership statisitcs for CENTURY III, INC. ANCILLARY PLAN

Measure Date Value
2022: CENTURY III, INC. ANCILLARY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-05-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 0
Number of retired or separated participants receiving benefits 2022-05-01 0
Number of other retired or separated participants entitled to future benefits 2022-05-01 0
Total of all active and inactive participants 2022-05-01 0
Number of employers contributing to the scheme 2022-05-01 0

Measure	Date	Value
2022: CENTURY III, INC. ANCILLARY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-05-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	0
Number of retired or separated participants receiving benefits	2022-05-01	0
Number of other retired or separated participants entitled to future benefits	2022-05-01	0
Total of all active and inactive participants	2022-05-01	0
Number of employers contributing to the scheme	2022-05-01	0

Form 5500 Responses for CENTURY III, INC. ANCILLARY PLAN

2022: CENTURY III, INC. ANCILLARY PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	First time form 5500 has been submitted	Yes
2022-05-01	This submission is the final filing	Yes
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

440831

Policy instance

Insurance contract or identification number	440831
Number of Individuals Covered	127
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $25,858
Total amount of fees paid to insurance company	USD $1,160
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $132,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,254
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

440834

Policy instance

Insurance contract or identification number	440834
Number of Individuals Covered	101
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $10,205
Total amount of fees paid to insurance company	USD $595
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,873
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )

Policy contract number

440835

Policy instance

Insurance contract or identification number	440835
Number of Individuals Covered	82
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $2,242
Total amount of fees paid to insurance company	USD $299
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $12,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,041
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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Company Name:	CENTURY III, INC.
Employer identification number (EIN):	570650616
NAIC Classification:	541600

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2008-08-18
Company Identification Number:	P08000076786
Legal Registered Office Address:	8096 vistaview place Frisco 75034