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HIGHLAND CARE CENTER, INC. 401(K) PLAN 401k Plan overview

Plan NameHIGHLAND CARE CENTER, INC. 401(K) PLAN
Plan identification number 002

HIGHLAND CARE CENTER, INC. 401(K) 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.
  • 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.

401k Sponsoring company profile

HIGHLAND CARE CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:HIGHLAND CARE CENTER, INC.
Employer identification number (EIN):112716287
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about HIGHLAND CARE CENTER, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1989-02-27
Company Identification Number: 1329650
Legal Registered Office Address: 4 CANAAN CIRCLE
Queens
SOUTH SALEM
United States of America (USA)
10590

More information about HIGHLAND CARE CENTER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HIGHLAND CARE CENTER, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022019-01-01
0022018-01-01
0022017-01-01MARY ANNE ROSE MARY ANNE ROSE2018-09-15
0022016-01-01MARY ANNE ROSE MARY ANNE ROSE2017-09-18
0022015-01-01MARY ANNE ROSE MARY ANNE ROSE2016-09-29
0022014-01-01MARY ANNE ROSE MARY ANNE ROSE2015-09-23
0022013-01-01MARY ANNE ROSE MARY ANNE ROSE2014-10-14
0022012-01-01MARY ANNE ROSE MARY ANNE ROSE2013-10-15
0022011-01-01MARY ANNE ROSE MARY ANNE ROSE2012-07-26
0022009-01-01MORDECAI ZIDELE MORDECAI ZIDELE2010-07-27

Plan Statistics for HIGHLAND CARE CENTER, INC. 401(K) PLAN

401k plan membership statisitcs for HIGHLAND CARE CENTER, INC. 401(K) PLAN

Measure Date Value
2019: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-014
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-010
Number of participants with account balances2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0119
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-014
Total of all active and inactive participants2018-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-014
Number of participants with account balances2018-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0119
Total number of active participants reported on line 7a of the Form 55002017-01-0115
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-012
Total of all active and inactive participants2017-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0117
Number of participants with account balances2017-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0134
Total number of active participants reported on line 7a of the Form 55002016-01-0117
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-012
Total of all active and inactive participants2016-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0119
Number of participants with account balances2016-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0134
Total number of active participants reported on line 7a of the Form 55002015-01-0132
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 participants2015-01-0134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0134
Number of participants with account balances2015-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0137
Total number of active participants reported on line 7a of the Form 55002014-01-0131
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 participants2014-01-0134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0134
Number of participants with account balances2014-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0146
Total number of active participants reported on line 7a of the Form 55002013-01-0132
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-015
Total of all active and inactive participants2013-01-0137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0137
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: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0153
Total number of active participants reported on line 7a of the Form 55002012-01-0140
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-016
Total of all active and inactive participants2012-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0146
Number of participants with account balances2012-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0149
Total number of active participants reported on line 7a of the Form 55002011-01-0146
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-016
Total of all active and inactive participants2011-01-0152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0152
Number of participants with account balances2011-01-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0147
Total number of active participants reported on line 7a of the Form 55002009-01-0141
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-014
Total of all active and inactive participants2009-01-0145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0145
Number of participants with account balances2009-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on HIGHLAND CARE CENTER, INC. 401(K) PLAN

Measure Date Value
2019 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2019 401k financial data
Total income from all sources2019-04-30$7,269
Expenses. Total of all expenses incurred2019-04-30$120,505
Benefits paid (including direct rollovers)2019-04-30$120,505
Total plan assets at end of year2019-04-30$0
Total plan assets at beginning of year2019-04-30$113,236
Value of fidelity bond covering the plan2019-04-30$100,000
Other income received2019-04-30$7,269
Net income (gross income less expenses)2019-04-30$-113,236
Net plan assets at end of year (total assets less liabilities)2019-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2019-04-30$113,236
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-04-30$0
2018 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$-11,220
Expenses. Total of all expenses incurred2018-12-31$175,489
Benefits paid (including direct rollovers)2018-12-31$175,489
Total plan assets at end of year2018-12-31$113,236
Total plan assets at beginning of year2018-12-31$299,945
Value of fidelity bond covering the plan2018-12-31$100,000
Other income received2018-12-31$-11,220
Net income (gross income less expenses)2018-12-31$-186,709
Net plan assets at end of year (total assets less liabilities)2018-12-31$113,236
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$299,945
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$15,637
Expenses. Total of all expenses incurred2017-12-31$180,604
Benefits paid (including direct rollovers)2017-12-31$180,604
Total plan assets at end of year2017-12-31$299,945
Total plan assets at beginning of year2017-12-31$464,912
Value of fidelity bond covering the plan2017-12-31$100,000
Other income received2017-12-31$15,637
Net income (gross income less expenses)2017-12-31$-164,967
Net plan assets at end of year (total assets less liabilities)2017-12-31$299,945
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$464,912
Assets. Value of participant loans2017-12-31$166
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022017-12-31$5,842
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2016 401k financial data
Total income from all sources2016-12-31$5,612
Expenses. Total of all expenses incurred2016-12-31$0
Total plan assets at end of year2016-12-31$464,912
Total plan assets at beginning of year2016-12-31$459,300
Value of fidelity bond covering the plan2016-12-31$100,000
Other income received2016-12-31$5,612
Net income (gross income less expenses)2016-12-31$5,612
Net plan assets at end of year (total assets less liabilities)2016-12-31$464,912
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$459,300
Assets. Value of participant loans2016-12-31$376
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022016-12-31$5,620
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2015 401k financial data
Total income from all sources2015-12-31$-272
Expenses. Total of all expenses incurred2015-12-31$49,778
Benefits paid (including direct rollovers)2015-12-31$49,778
Total plan assets at end of year2015-12-31$459,300
Total plan assets at beginning of year2015-12-31$509,350
Value of fidelity bond covering the plan2015-12-31$100,000
Other income received2015-12-31$-272
Net income (gross income less expenses)2015-12-31$-50,050
Net plan assets at end of year (total assets less liabilities)2015-12-31$459,300
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$509,350
Assets. Value of participant loans2015-12-31$611
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022015-12-31$5,389
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2014 401k financial data
Total income from all sources2014-12-31$5,703
Expenses. Total of all expenses incurred2014-12-31$65,136
Benefits paid (including direct rollovers)2014-12-31$64,986
Total plan assets at end of year2014-12-31$509,350
Total plan assets at beginning of year2014-12-31$568,783
Value of fidelity bond covering the plan2014-12-31$100,000
Other income received2014-12-31$5,703
Net income (gross income less expenses)2014-12-31$-59,433
Net plan assets at end of year (total assets less liabilities)2014-12-31$509,350
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$568,783
Assets. Value of participant loans2014-12-31$803
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022014-12-31$5,167
Value of certain deemed distributions of participant loans2014-12-31$150
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$21,680
Expenses. Total of all expenses incurred2013-12-31$111,155
Benefits paid (including direct rollovers)2013-12-31$110,930
Total plan assets at end of year2013-12-31$568,783
Total plan assets at beginning of year2013-12-31$658,258
Value of fidelity bond covering the plan2013-12-31$100,000
Other income received2013-12-31$21,680
Net income (gross income less expenses)2013-12-31$-89,475
Net plan assets at end of year (total assets less liabilities)2013-12-31$568,783
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$658,258
Assets. Value of participant loans2013-12-31$5,454
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022013-12-31$3,567
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$225
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$53,395
Expenses. Total of all expenses incurred2012-12-31$560,474
Benefits paid (including direct rollovers)2012-12-31$560,238
Total plan assets at end of year2012-12-31$658,258
Total plan assets at beginning of year2012-12-31$1,165,337
Value of fidelity bond covering the plan2012-12-31$100,000
Total contributions received or receivable from participants2012-12-31$38,630
Other income received2012-12-31$14,765
Net income (gross income less expenses)2012-12-31$-507,079
Net plan assets at end of year (total assets less liabilities)2012-12-31$658,258
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,165,337
Assets. Value of participant loans2012-12-31$6,172
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022012-12-31$25,414
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$236
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2011 401k financial data
Total income from all sources2011-12-31$106,398
Expenses. Total of all expenses incurred2011-12-31$5,263
Benefits paid (including direct rollovers)2011-12-31$4,963
Total plan assets at end of year2011-12-31$1,165,337
Total plan assets at beginning of year2011-12-31$1,064,202
Value of fidelity bond covering the plan2011-12-31$100,000
Total contributions received or receivable from participants2011-12-31$97,953
Other income received2011-12-31$8,445
Net income (gross income less expenses)2011-12-31$101,135
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,165,337
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,064,202
Assets. Value of participant loans2011-12-31$10,870
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$300
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 2010 401k financial data
Total income from all sources2010-12-31$114,082
Expenses. Total of all expenses incurred2010-12-31$52,490
Benefits paid (including direct rollovers)2010-12-31$47,452
Total plan assets at end of year2010-12-31$1,064,202
Total plan assets at beginning of year2010-12-31$1,002,610
Value of fidelity bond covering the plan2010-12-31$100,000
Total contributions received or receivable from participants2010-12-31$94,425
Other income received2010-12-31$19,657
Net income (gross income less expenses)2010-12-31$61,592
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,064,202
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,002,610
Assets. Value of participant loans2010-12-31$2,800
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$5,038
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 HIGHLAND CARE CENTER, INC. 401(K) PLAN

2019: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 filingYes
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: HIGHLAND CARE CENTER, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: HIGHLAND CARE CENTER, INC. 401(K) PLAN 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 – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117348
Policy instance 1
Insurance contract or identification numberNYU0117348
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $563
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 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
Amount paid for insurance broker fees563
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117348
Policy instance 1
Insurance contract or identification numberNYU0117348
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $563
Are there contracts with allocated funds for individual policies?Yes
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 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
Amount paid for insurance broker fees563
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117348
Policy instance 1
Insurance contract or identification numberNYU0117348
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $563
Are there contracts with allocated funds for individual policies?Yes
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 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
Amount paid for insurance broker fees563
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117348
Policy instance 1
Insurance contract or identification numberNYU0117348
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $563
Are there contracts with allocated funds for individual policies?Yes
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 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
Amount paid for insurance broker fees563
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117348
Policy instance 1
Insurance contract or identification numberNYU0117348
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $563
Are there contracts with allocated funds for individual policies?Yes
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 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
Amount paid for insurance broker fees563
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117345
Policy instance 3
Insurance contract or identification numberNYU0117345
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-06-14
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $650
Are there contracts with allocated funds for individual policies?Yes
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 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
Amount paid for insurance broker fees650
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract numberUL1204102
Policy instance 2
Insurance contract or identification numberUL1204102
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-05-11
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?Yes
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 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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameCHERNOFF DIAMOND & CO., LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract numberUL1204102
Policy instance 1
Insurance contract or identification numberUL1204102
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $112
Total amount of fees paid to insurance companyUSD $3,750
Are there contracts with allocated funds for individual policies?Yes
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 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
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117345
Policy instance 2
Insurance contract or identification numberNYU0117345
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $650
Are there contracts with allocated funds for individual policies?Yes
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 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
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117348
Policy instance 3
Insurance contract or identification numberNYU0117348
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $563
Are there contracts with allocated funds for individual policies?Yes
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 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
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117345
Policy instance 2
Insurance contract or identification numberNYU0117345
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $650
Are there contracts with allocated funds for individual policies?Yes
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 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
Amount paid for insurance broker fees650
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
WILLIAM PENN (National Association of Insurance Commissioners NAIC id number: 66230 )
Policy contract numberNYU0117348
Policy instance 3
Insurance contract or identification numberNYU0117348
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $563
Are there contracts with allocated funds for individual policies?Yes
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 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
Amount paid for insurance broker fees563
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameWILLIAM PENN LIFE INS. CO OF NY
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract numberUL1204102
Policy instance 1
Insurance contract or identification numberUL1204102
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $112
Total amount of fees paid to insurance companyUSD $3,750
Are there contracts with allocated funds for individual policies?Yes
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 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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3750
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameCHERNOFF DIAMOND & CO., LLC

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