401k Plan data: CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN plan

CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN
Plan identification number	506

CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CALDWELL MANUFACTURING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: CALDWELL MANUFACTURING COMPANY

Employer identification number (EIN): 160372360

NAIC Classification: 332900

Additional information about CALDWELL MANUFACTURING COMPANY

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1910-01-04

Company Identification Number: 29423

Legal Registered Office Address: 2605 Manitou Road
Monroe
Rochester
United States of America (USA)
14620

More information about CALDWELL MANUFACTURING COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2017-01-01 ROBERT LELIO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
506	2017-01-01	ROBERT LELIO

Plan Statistics for CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN

Measure Date Value
2017: CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 263
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 241
Number of retired or separated participants receiving benefits 2017-01-01 22
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 263
Total participants 2017-01-01 263

Measure	Date	Value
2017: CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	263
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	241
Number of retired or separated participants receiving benefits	2017-01-01	22
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	263
Total participants	2017-01-01	263

Form 5500 Responses for CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN

2017: CALDWELL MANUFACTURING COMPANY NORTH AMERICA, LLC HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

00017061

Policy instance

Insurance contract or identification number	00017061
Number of Individuals Covered	162
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $58,786
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,786
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

10031061001

Policy instance

Insurance contract or identification number	10031061001
Number of Individuals Covered	210
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,418
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,418
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010177098

Policy instance

Insurance contract or identification number	000010177098
Number of Individuals Covered	269
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,051
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $44,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,051
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000403002238

Policy instance

Insurance contract or identification number	000403002238
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 $668
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $668
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010177099

Policy instance

Insurance contract or identification number	000010177099
Number of Individuals Covered	89
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,357
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,357
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

BTA-120958

Policy instance

Insurance contract or identification number	BTA-120958
Number of Individuals Covered	38
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $269
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $269
Insurance broker organization code?	3
Insurance broker name	M&T INSURANCE AGENCY, INC.

Potentially related plans

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Company Name:	CALDWELL MANUFACTURING COMPANY
Employer identification number (EIN):	160372360
NAIC Classification:	332900

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1910-01-04
Company Identification Number:	29423
Legal Registered Office Address:	2605 Manitou Road Monroe Rochester United States of America (USA) 14620