401k Plan data: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN plan

NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 401k Plan overview

Plan Name	NICOLON CORPORATION FULLY INSURED BENEFITS PLAN
Plan identification number	503

NICOLON CORPORATION FULLY INSURED BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

NICOLON CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: NICOLON CORPORATION

Employer identification number (EIN): 570603223

NAIC Classification: 314000
NAIC Description: Textile Product Mills

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NICOLON CORPORATION FULLY INSURED BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-01-01 RANDALL ADAMS 2022-10-17
503 2021-01-01 JONATHAN MCELHANNON 2023-10-16
503 2020-01-01 RANDALL ADAMS 2021-10-15
503 2019-01-01 RANDALL ADAMS 2020-10-13
503 2018-01-01 RANDALL ADAMS 2019-10-28
503 2018-01-01 RANDALL ADAMS 2019-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2021-01-01	RANDALL ADAMS	2022-10-17
503	2021-01-01	JONATHAN MCELHANNON	2023-10-16
503	2020-01-01	RANDALL ADAMS	2021-10-15
503	2019-01-01	RANDALL ADAMS	2020-10-13
503	2018-01-01	RANDALL ADAMS	2019-10-28
503	2018-01-01	RANDALL ADAMS	2019-10-15

Plan Statistics for NICOLON CORPORATION FULLY INSURED BENEFITS PLAN

401k plan membership statisitcs for NICOLON CORPORATION FULLY INSURED BENEFITS PLAN

Measure Date Value
2021: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 752
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 719
Total of all active and inactive participants 2021-01-01 719
2020: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 727
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 752
Total of all active and inactive participants 2020-01-01 752
2019: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 631
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 727
Total of all active and inactive participants 2019-01-01 727
2018: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 402
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 631
Total of all active and inactive participants 2018-01-01 631

Measure	Date	Value
2021: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	752
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	719
Total of all active and inactive participants	2021-01-01	719
2020: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	727
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	752
Total of all active and inactive participants	2020-01-01	752
2019: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	631
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	727
Total of all active and inactive participants	2019-01-01	727
2018: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	402
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	631
Total of all active and inactive participants	2018-01-01	631

Financial Data on NICOLON CORPORATION FULLY INSURED BENEFITS PLAN

Measure	Date	Value
2021 : NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2021 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	No
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
Did the plan have assets held for investment	2021-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	Yes

Form 5500 Responses for NICOLON CORPORATION FULLY INSURED BENEFITS PLAN

2021: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	This submission is the final filing	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: NICOLON CORPORATION FULLY INSURED BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

NYDI-0000037024

Policy instance

Insurance contract or identification number	NYDI-0000037024
Number of Individuals Covered	2
Insurance policy start date	2021-06-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NY DISABILITY BENEFITS LAW
Welfare Benefit Premiums Paid to Carrier	USD $65
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186414

Policy instance

Insurance contract or identification number	000010186414
Number of Individuals Covered	1168
Insurance policy start date	2021-01-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $3,837
Total amount of fees paid to insurance company	USD $1,918
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D, DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $38,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,837
Insurance broker organization code?	3
Amount paid for insurance broker fees	1918

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186416

Policy instance

Insurance contract or identification number	000010186416
Number of Individuals Covered	200
Insurance policy start date	2021-01-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $8,268
Total amount of fees paid to insurance company	USD $3,231
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $55,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,268
Insurance broker organization code?	3
Amount paid for insurance broker fees	3231

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010254423

Policy instance

Insurance contract or identification number	000010254423
Number of Individuals Covered	57
Insurance policy start date	2021-01-01
Insurance policy end date	2021-05-21
Total amount of commissions paid to insurance broker	USD $5,863
Total amount of fees paid to insurance company	USD $1,954
Other welfare benefits provided	LONG-TERM DISABILITY - GA
Welfare Benefit Premiums Paid to Carrier	USD $39,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,863
Insurance broker organization code?	3
Amount paid for insurance broker fees	1954

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

LIFE-0000028008

Policy instance

Insurance contract or identification number	LIFE-0000028008
Number of Individuals Covered	241
Insurance policy start date	2021-06-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $7,418
Total amount of fees paid to insurance company	USD $2,473
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,418
Insurance broker organization code?	3
Amount paid for insurance broker fees	2473
Additional information about fees paid to insurance broker	CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

LTD-0000028009

Policy instance

Insurance contract or identification number	LTD-0000028009
Number of Individuals Covered	140
Insurance policy start date	2021-06-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $999
Total amount of fees paid to insurance company	USD $499
Other welfare benefits provided	PAID SALARIED LT DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $9,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $999
Insurance broker organization code?	3
Amount paid for insurance broker fees	499
Additional information about fees paid to insurance broker	CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

LTD-0000031996

Policy instance

Insurance contract or identification number	LTD-0000031996
Number of Individuals Covered	88
Insurance policy start date	2021-06-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $1,581
Total amount of fees paid to insurance company	USD $527
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,581
Insurance broker organization code?	3
Amount paid for insurance broker fees	527
Additional information about fees paid to insurance broker	CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

LIFE-0000028007

Policy instance

Insurance contract or identification number	LIFE-0000028007
Number of Individuals Covered	449
Insurance policy start date	2021-06-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $1,933
Total amount of fees paid to insurance company	USD $966
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,933
Insurance broker organization code?	3
Amount paid for insurance broker fees	966
Additional information about fees paid to insurance broker	CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

STD-0000028006

Policy instance

Insurance contract or identification number	STD-0000028006
Number of Individuals Covered	200
Insurance policy start date	2021-06-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $3,984
Total amount of fees paid to insurance company	USD $1,328
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $26,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,984
Insurance broker organization code?	3
Amount paid for insurance broker fees	1328
Additional information about fees paid to insurance broker	CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010254423

Policy instance

Insurance contract or identification number	000010254423
Number of Individuals Covered	87
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,405
Total amount of fees paid to insurance company	USD $3,551
Other welfare benefits provided	LONG-TERM DISABILITY - GA
Welfare Benefit Premiums Paid to Carrier	USD $36,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,405
Insurance broker organization code?	3
Amount paid for insurance broker fees	3551
Additional information about fees paid to insurance broker	BROKER BONUS AND CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186416

Policy instance

Insurance contract or identification number	000010186416
Number of Individuals Covered	177
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $14,777
Total amount of fees paid to insurance company	USD $9,829
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $98,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,777
Insurance broker organization code?	3
Amount paid for insurance broker fees	9829
Additional information about fees paid to insurance broker	BROKER BONUS AND CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186415

Policy instance

Insurance contract or identification number	000010186415
Number of Individuals Covered	129
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,596
Total amount of fees paid to insurance company	USD $5,760
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5760
Additional information about fees paid to insurance broker	BROKER BONUS AND CONSULTING FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,596

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

18022

Policy instance

Insurance contract or identification number	18022
Number of Individuals Covered	529
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $28,105
Total amount of fees paid to insurance company	USD $26,262
Other welfare benefits provided	VOL. LIFE VOL. CHILD & SPOUSE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $187,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,105
Insurance broker organization code?	3
Amount paid for insurance broker fees	26262
Additional information about fees paid to insurance broker	BROKER BONUS AND CONSULTING FEES

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186414

Policy instance

Insurance contract or identification number	000010186414
Number of Individuals Covered	717
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,381
Total amount of fees paid to insurance company	USD $12,272
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D, DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $73,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	12272
Additional information about fees paid to insurance broker	BROKER BONUS AND CONSULTING FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $7,381

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

18022

Policy instance

Insurance contract or identification number	18022
Number of Individuals Covered	501
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $22,649
Total amount of fees paid to insurance company	USD $7,550
Other welfare benefits provided	VOL. LIFE VOL. CHILD & SPOUSE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $150,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,649
Insurance broker organization code?	3
Amount paid for insurance broker fees	7550

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186415

Policy instance

Insurance contract or identification number	000010186415
Number of Individuals Covered	129
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,796
Total amount of fees paid to insurance company	USD $1,398
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,796
Insurance broker organization code?	3
Amount paid for insurance broker fees	1398

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186416

Policy instance

Insurance contract or identification number	000010186416
Number of Individuals Covered	177
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,374
Total amount of fees paid to insurance company	USD $4,458
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $89,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,374
Insurance broker organization code?	3
Amount paid for insurance broker fees	4458

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186414

Policy instance

Insurance contract or identification number	000010186414
Number of Individuals Covered	1160
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,866
Total amount of fees paid to insurance company	USD $2,933
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D, DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $58,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,866
Insurance broker organization code?	3
Amount paid for insurance broker fees	2933

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186414

Policy instance

Insurance contract or identification number	000010186414
Number of Individuals Covered	1909
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,551
Total amount of fees paid to insurance company	USD $1,628
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D, DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $85,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,551
Insurance broker organization code?	3
Amount paid for insurance broker fees	1628
Additional information about fees paid to insurance broker	CONSULTING

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186415

Policy instance

Insurance contract or identification number	000010186415
Number of Individuals Covered	210
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,838
Total amount of fees paid to insurance company	USD $1,069
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,838
Insurance broker organization code?	3
Amount paid for insurance broker fees	1069
Additional information about fees paid to insurance broker	CONSULTING

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010186416

Policy instance

Insurance contract or identification number	000010186416
Number of Individuals Covered	177
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $11,584
Total amount of fees paid to insurance company	USD $1,340
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $77,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,584
Amount paid for insurance broker fees	1340
Additional information about fees paid to insurance broker	CONSULTING
Insurance broker organization code?	0

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

18022

Policy instance

Insurance contract or identification number	18022
Number of Individuals Covered	864
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $32,300
Total amount of fees paid to insurance company	USD $4,403
Other welfare benefits provided	VOL. LIFE VOL. CHILD & SPOUSE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $215,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4403
Additional information about fees paid to insurance broker	CONSULTING
Insurance broker organization code?	0
Commission paid to Insurance Broker	USD $32,300

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Company Name:	NICOLON CORPORATION
Employer identification number (EIN):	570603223
NAIC Classification:	314000
NAIC Description:	Textile Product Mills