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AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 401k Plan overview

Plan NameAJAX PAVING INDUSTRIES, INC. 401(K) PLAN
Plan identification number 001

AJAX PAVING INDUSTRIES, INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

AJAX PAVING INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:AJAX PAVING INDUSTRIES, INC.
Employer identification number (EIN):381383205
NAIC Classification:237310
NAIC Description:Highway, Street, and Bridge Construction

Additional information about AJAX PAVING INDUSTRIES, INC.

Jurisdiction of Incorporation: Michigan Secretary of State
Incorporation Date: 0000-00-00
Company Identification Number: 163244
Legal Registered Office Address: 601 ABBOT ROAD EAST LANSING


United States of America (USA)
48823

More information about AJAX PAVING INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AJAX PAVING INDUSTRIES, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012020-01-01
0012019-01-01
0012018-01-01JAMES M FRIEL2019-06-04 JAMES M FRIEL2019-06-04
0012017-01-01JAMES FRIEL2018-05-29 JAMES FRIEL2018-05-29
0012016-01-01JAMES FRIEL2017-05-05 JAMES FRIEL2017-05-05
0012015-01-01JAMES FRIEL2016-07-25 JAMES FRIEL2016-07-25
0012014-01-01JAMES FRIEL2015-09-15 JAMES FRIEL2015-09-15
0012013-01-01JAMES M. FRIEL2014-07-08 JAMES M. FRIEL2014-07-08
0012012-01-01JAMES M FRIEL2013-07-16 JAMES M FRIEL2013-07-16
0012011-01-01JAMES M. FRIEL2012-10-15 JAMES M. FRIEL2012-10-15
0012010-01-01JAMES FRIEL2011-10-14 JAMES FRIEL2011-10-14

Plan Statistics for AJAX PAVING INDUSTRIES, INC. 401(K) PLAN

401k plan membership statisitcs for AJAX PAVING INDUSTRIES, INC. 401(K) PLAN

Measure Date Value
2022: AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01131
Total number of active participants reported on line 7a of the Form 55002022-01-01115
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0114
Total of all active and inactive participants2022-01-01129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-011
Total participants2022-01-01130
Number of participants with account balances2022-01-01130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0110
2020: AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01127
Total number of active participants reported on line 7a of the Form 55002020-01-01113
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0112
Total of all active and inactive participants2020-01-01125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-011
Total participants2020-01-01126
Number of participants with account balances2020-01-01126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-014
2019: AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01122
Total number of active participants reported on line 7a of the Form 55002019-01-01117
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0111
Total of all active and inactive participants2019-01-01128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-011
Total participants2019-01-01129
Number of participants with account balances2019-01-01125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-013

Financial Data on AJAX PAVING INDUSTRIES, INC. 401(K) PLAN

Measure Date Value
2022 : AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets from this plan2022-12-31$11,192
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-5,302,873
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,824,420
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,732,033
Expenses. Certain deemed distributions of participant loans2022-12-31$40,102
Value of total corrective distributions2022-12-31$11,316
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,906,203
Value of total assets at end of year2022-12-31$41,005,125
Value of total assets at beginning of year2022-12-31$48,143,610
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$40,969
Total interest from all sources2022-12-31$1,909,749
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$888,491
Participant contributions at end of year2022-12-31$79,719
Participant contributions at beginning of year2022-12-31$116,533
Participant contributions at end of year2022-12-31$26,000
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$21,728
Other income not declared elsewhere2022-12-31$5,317
Administrative expenses (other) incurred2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-7,127,293
Value of net assets at end of year (total assets less liabilities)2022-12-31$41,005,125
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$48,143,610
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$34,608,176
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$41,302,884
Interest on participant loans2022-12-31$5,661
Interest earned on other investments2022-12-31$1,904,088
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$4,295,246
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$4,639,788
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-10,124,142
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$1,995,984
Employer contributions (assets) at end of year2022-12-31$1,995,984
Employer contributions (assets) at beginning of year2022-12-31$2,084,405
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,732,033
Contract administrator fees2022-12-31$40,969
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31GRANT MILLMAN & JOHNSON
Accountancy firm EIN2022-12-31382555519
2021 : AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$9,132,525
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$3,474,810
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$3,436,431
Expenses. Certain deemed distributions of participant loans2021-12-31$21,128
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$3,032,176
Value of total assets at end of year2021-12-31$48,143,610
Value of total assets at beginning of year2021-12-31$42,485,895
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$17,251
Total interest from all sources2021-12-31$3,875,454
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$866,126
Participant contributions at end of year2021-12-31$116,533
Participant contributions at beginning of year2021-12-31$102,498
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$81,645
Other income not declared elsewhere2021-12-31$7,655
Administrative expenses (other) incurred2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$5,657,715
Value of net assets at end of year (total assets less liabilities)2021-12-31$48,143,610
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$42,485,895
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$41,302,884
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$35,866,547
Interest on participant loans2021-12-31$7,041
Interest earned on other investments2021-12-31$3,868,413
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$4,639,788
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$4,529,128
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$2,217,240
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$2,084,405
Employer contributions (assets) at end of year2021-12-31$2,084,405
Employer contributions (assets) at beginning of year2021-12-31$1,987,722
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$3,436,431
Contract administrator fees2021-12-31$17,251
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31GRANT MILLMAN & JOHNSON
Accountancy firm EIN2021-12-31382555519
2020 : AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$7,994,815
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$2,110,712
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$2,071,404
Expenses. Certain deemed distributions of participant loans2020-12-31$16,220
Value of total corrective distributions2020-12-31$13,910
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$2,749,355
Value of total assets at end of year2020-12-31$42,485,895
Value of total assets at beginning of year2020-12-31$36,601,792
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$9,178
Total interest from all sources2020-12-31$1,984,226
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$758,451
Participant contributions at end of year2020-12-31$102,498
Participant contributions at beginning of year2020-12-31$166,694
Participant contributions at beginning of year2020-12-31$-25,598
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$3,182
Other income not declared elsewhere2020-12-31$7,473
Administrative expenses (other) incurred2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$5,884,103
Value of net assets at end of year (total assets less liabilities)2020-12-31$42,485,895
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$36,601,792
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$35,866,547
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$30,847,796
Interest on participant loans2020-12-31$9,403
Interest earned on other investments2020-12-31$1,974,823
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$4,529,128
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$3,919,975
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$3,253,761
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$1,987,722
Employer contributions (assets) at end of year2020-12-31$1,987,722
Employer contributions (assets) at beginning of year2020-12-31$1,692,925
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$2,071,404
Contract administrator fees2020-12-31$9,178
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31GRANT MILLMAN & JOHNSON
Accountancy firm EIN2020-12-31382555519
2019 : AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$10,009,612
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$6,059,012
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$5,983,662
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$2,445,236
Value of total assets at end of year2019-12-31$36,601,792
Value of total assets at beginning of year2019-12-31$32,651,192
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$75,350
Total interest from all sources2019-12-31$1,925,257
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$662,750
Participant contributions at end of year2019-12-31$166,694
Participant contributions at beginning of year2019-12-31$135,389
Participant contributions at end of year2019-12-31$-25,598
Participant contributions at beginning of year2019-12-31$17,750
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$89,561
Other income not declared elsewhere2019-12-31$113,124
Administrative expenses (other) incurred2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$3,950,600
Value of net assets at end of year (total assets less liabilities)2019-12-31$36,601,792
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$32,651,192
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$30,847,796
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$28,046,377
Interest on participant loans2019-12-31$8,695
Interest earned on other investments2019-12-31$1,916,562
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$3,919,975
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$2,806,726
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$5,525,995
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$1,692,925
Employer contributions (assets) at end of year2019-12-31$1,692,925
Employer contributions (assets) at beginning of year2019-12-31$1,644,950
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$5,983,662
Contract administrator fees2019-12-31$75,350
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31GRANT MILLMAN & JOHNSON
Accountancy firm EIN2019-12-31382555519

Form 5500 Responses for AJAX PAVING INDUSTRIES, INC. 401(K) PLAN

2022: AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2020: AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: AJAX PAVING INDUSTRIES, INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number333842-01
Policy instance 1
Insurance contract or identification number333842-01
Number of Individuals Covered50
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,322
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,843
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number333842-01
Policy instance 1
Insurance contract or identification number333842-01
Number of Individuals Covered47
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,735
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,735
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number333842-01
Policy instance 1
Insurance contract or identification number333842-01
Number of Individuals Covered39
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,386
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,386
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number333842-01
Policy instance 1
Insurance contract or identification number333842-01
Number of Individuals Covered23
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,384
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,384
Insurance broker organization code?3

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