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| Plan Name | CARITHERS WALLACE COURTENAY, LLC BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CARITHERS WALLACE COURTENAY, LLC |
| Employer identification number (EIN): | 824173532 |
| NAIC Classification: | 442110 |
| NAIC Description: | Furniture Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-01-01 | ||||
| 501 | 2021-01-01 | MIMI AMATRUDA | |||
| 501 | 2020-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2021: CARITHERS WALLACE COURTENAY, LLC BENEFITS PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 82 |
| Total of all active and inactive participants | 2021-01-01 | 82 |
| 2020: CARITHERS WALLACE COURTENAY, LLC BENEFITS PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 99 |
| Total of all active and inactive participants | 2020-01-01 | 99 |
| 2021: CARITHERS WALLACE COURTENAY, LLC BENEFITS PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: CARITHERS WALLACE COURTENAY, LLC BENEFITS PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) | |
| Policy contract number | GA6801 |
| Policy instance | 1 |
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) | |
| Policy contract number | GA3175 |
| Policy instance | 2 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 417002414313 |
| Policy instance | 3 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | H8033 |
| Policy instance | 4 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | H8033 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 417002414313 |
| Policy instance | 2 |
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) | |
| Policy contract number | GA3175 |
| Policy instance | 3 |
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) | |
| Policy contract number | GA6801 |
| Policy instance | 4 |
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