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| Plan Name | OSIB50TH STREET OPERATOR, LLC |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | OSIB 50TH ST OPERATOR LLC DBA CITIZENM HOTELS |
| Employer identification number (EIN): | 331220732 |
| NAIC Classification: | 721110 |
| NAIC Description: | Hotels (except Casino Hotels) and Motels |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-04-01 | JOANNA DODARO | 2023-09-06 | ||
| 501 | 2020-04-01 | JOANNA DODARO | 2021-11-10 |
| Measure | Date | Value |
|---|---|---|
| 2022: OSIB50TH STREET OPERATOR, LLC 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-04-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 290 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
| Total of all active and inactive participants | 2022-04-01 | 291 |
| Number of employers contributing to the scheme | 2022-04-01 | 0 |
| 2020: OSIB50TH STREET OPERATOR, LLC 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-04-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 82 |
| Number of retired or separated participants receiving benefits | 2020-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
| Total of all active and inactive participants | 2020-04-01 | 82 |
| Number of employers contributing to the scheme | 2020-04-01 | 0 |
| 2022: OSIB50TH STREET OPERATOR, LLC 2022 form 5500 responses | ||
|---|---|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: OSIB50TH STREET OPERATOR, LLC 2020 form 5500 responses | ||
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | First time form 5500 has been submitted | Yes |
| 2020-04-01 | Plan funding arrangement – Insurance | Yes |
| 2020-04-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 499201 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 300343 | ||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 499201 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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