401k Plan data: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN plan

CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 401k Plan overview

Plan Name	CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN
Plan identification number	507

CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN Benefits

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

401k Sponsoring company profile

CIRCA LIGHTING has sponsored the creation of one or more 401k plans.

Company Name: CIRCA LIGHTING

Employer identification number (EIN): 582404082

NAIC Classification: 335100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2021-01-01 MICHAEL ABRAMOVITZ 2022-10-04
507 2020-01-01 JOE MILLER 2021-10-04
507 2019-01-01 JOSEPH E. MILLER 2020-10-02
507 2018-01-01 BETSY MORTON 2019-09-23
507 2018-01-01 BETSY MORTON 2019-09-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
507	2021-01-01	MICHAEL ABRAMOVITZ	2022-10-04
507	2020-01-01	JOE MILLER	2021-10-04
507	2019-01-01	JOSEPH E. MILLER	2020-10-02
507	2018-01-01	BETSY MORTON	2019-09-23
507	2018-01-01	BETSY MORTON	2019-09-23

Plan Statistics for CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN

401k plan membership statisitcs for CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN

Measure Date Value
2021: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 204
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 204
Number of employers contributing to the scheme 2021-01-01 0
2020: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 154
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 156
Number of employers contributing to the scheme 2020-01-01 0
2019: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 132
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 132
Number of employers contributing to the scheme 2019-01-01 0
2018: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 87
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 87

Measure	Date	Value
2021: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	204
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	204
Number of employers contributing to the scheme	2021-01-01	0
2020: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	154
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	156
Number of employers contributing to the scheme	2020-01-01	0
2019: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	132
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	132
Number of employers contributing to the scheme	2019-01-01	0
2018: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	87
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	87

Form 5500 Responses for CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN

2021: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY 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: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY 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: CIRCA LIGHTING DENTAL, VISION, LIFE AND DISABILITY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5973982

Policy instance

Insurance contract or identification number	5973982
Number of Individuals Covered	1310
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $71
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $429,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

556581

Policy instance

Insurance contract or identification number	556581
Number of Individuals Covered	155
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,733
Total amount of fees paid to insurance company	USD $5,932
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $95,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $3,316
Amount paid for insurance broker fees	5690
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30086394

Policy instance

Insurance contract or identification number	30086394
Number of Individuals Covered	612
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $979
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $979
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

00556581

Policy instance

Insurance contract or identification number	00556581
Number of Individuals Covered	131
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,728
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $114,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,728
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30086394

Policy instance

Insurance contract or identification number	30086394
Number of Individuals Covered	626
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,709
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,709
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

001681

Policy instance

Insurance contract or identification number	001681
Number of Individuals Covered	193
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,070
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
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 $81,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	4070
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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Company Name:	CIRCA LIGHTING
Employer identification number (EIN):	582404082
NAIC Classification:	335100