401k Plan data: TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN plan

TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN 401k Plan overview

Plan Name	TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN
Plan identification number	505

TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	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 TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-01-01
505 2021-09-01

Plan Statistics for TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN

401k plan membership statisitcs for TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN

Measure Date Value
2022: TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 184
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 449
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 452
2021: TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-09-01 184
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 184
Number of retired or separated participants receiving benefits 2021-09-01 0
Number of other retired or separated participants entitled to future benefits 2021-09-01 0
Total of all active and inactive participants 2021-09-01 184

Measure	Date	Value
2022: TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	184
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	449
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	452
2021: TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	184
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	184
Number of retired or separated participants receiving benefits	2021-09-01	0
Number of other retired or separated participants entitled to future benefits	2021-09-01	0
Total of all active and inactive participants	2021-09-01	184

Form 5500 Responses for TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN

2022: TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: TENCATE GEOSYNTHETICS AMERICAS CRITICAL ILLNESS AND ACCIDENT PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	First time form 5500 has been submitted	Yes
2021-09-01	Submission has been amended	No
2021-09-01	This submission is the final filing	No
2021-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-09-01	Plan is a collectively bargained plan	No
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

12150

Policy instance

Insurance contract or identification number	12150
Number of Individuals Covered	211
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,367
Total amount of fees paid to insurance company	USD $143
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	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
Other welfare benefits provided	CRITICAL ILLNESS, CANCER AND ACCIDENT
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 $94,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,796
Insurance broker organization code?	3
Amount paid for insurance broker fees	143
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

12150

Policy instance

Insurance contract or identification number	12150
Number of Individuals Covered	218
Insurance policy start date	2021-09-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,674
Total amount of fees paid to insurance company	USD $0
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	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
Other welfare benefits provided	CRITICAL ILLNESS, CANCER AND ACCIDENT
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 $95,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,647
Insurance broker organization code?	3

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