401k Plan data: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN plan

NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 401k Plan overview

Plan Name	NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN
Plan identification number	501

NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Supplemental unemployment Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover 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

NOTEWORTHY INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: NOTEWORTHY INDUSTRIES, INC.

Employer identification number (EIN): 141540466

NAIC Classification: 326100

Additional information about NOTEWORTHY INDUSTRIES, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1971-03-18

Company Identification Number: 304515

Legal Registered Office Address: 336 FOREST AVENUE
Montgomery
AMSTERDAM
United States of America (USA)
12010

More information about NOTEWORTHY INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01
501 2017-01-01
501 2016-01-01 LINETTE WALING
501 2015-01-01 LINETTE WALING
501 2014-01-01 LINETTE WALING
501 2013-01-01 LINETTE WALING
501 2012-01-01 LINETTE WALING
501 2011-01-01 LINETTE COOLONG
501 2010-01-01 LINETTE COOLONG

Plan Statistics for NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN

401k plan membership statisitcs for NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN

Measure Date Value
2017: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 75
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 65
Total of all active and inactive participants 2017-01-01 65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
2016: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 75
Total of all active and inactive participants 2016-01-01 75
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
2015: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 147
Total of all active and inactive participants 2015-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
2014: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 146
Total of all active and inactive participants 2014-01-01 146
2013: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 101
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 101
2012: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 143
Total of all active and inactive participants 2012-01-01 143
2011: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 162
Total of all active and inactive participants 2011-01-01 162
2010: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 131
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 131

Measure	Date	Value
2017: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	75
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	65
Total of all active and inactive participants	2017-01-01	65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
2016: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	75
Total of all active and inactive participants	2016-01-01	75
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
2015: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	147
Total of all active and inactive participants	2015-01-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
2014: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	146
Total of all active and inactive participants	2014-01-01	146
2013: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	101
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	101
2012: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	143
Total of all active and inactive participants	2012-01-01	143
2011: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	162
Total of all active and inactive participants	2011-01-01	162
2010: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	131
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	131

Form 5500 Responses for NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN

2017: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: NOTEWORTHY INDUSTRIES, INC. HEALTH & LIFE INSURANCE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )

Policy contract number

20021612

Policy instance

Insurance contract or identification number	20021612
Number of Individuals Covered	91
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $24,044
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $545,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	24044
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	THE CAPITAL REGION STRATEGIC EBS LL

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00484014

Policy instance

Insurance contract or identification number	00484014
Number of Individuals Covered	65
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,179
Total amount of fees paid to insurance company	USD $3,284
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $42,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,131
Amount paid for insurance broker fees	3284
Additional information about fees paid to insurance broker	TOTAL FEES PAID
Insurance broker organization code?	3
Insurance broker name	WAG NEW YORK, INC.

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Company Name:	NOTEWORTHY INDUSTRIES, INC.
Employer identification number (EIN):	141540466
NAIC Classification:	326100

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1971-03-18
Company Identification Number:	304515
Legal Registered Office Address:	336 FOREST AVENUE Montgomery AMSTERDAM United States of America (USA) 12010