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ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN
Plan identification number 501

ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ROLLINGS FUNERAL SERVICE, INC. has sponsored the creation of one or more 401k plans.

Company Name:ROLLINGS FUNERAL SERVICE, INC.
Employer identification number (EIN):030410732
NAIC Classification:812210
NAIC Description:Funeral Homes and Funeral Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01GREGORY ROLLINGS2023-09-26
5012021-02-01GREG ROLLINGS2022-06-09

Plan Statistics for ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01178
Total number of active participants reported on line 7a of the Form 55002022-02-01243
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01243
Number of employers contributing to the scheme2022-02-010
2021: ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01217
Total number of active participants reported on line 7a of the Form 55002021-02-01207
Number of retired or separated participants receiving benefits2021-02-010
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01207
Number of employers contributing to the scheme2021-02-010

Form 5500 Responses for ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN

2022: ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: ROLLINGS FUNERAL SERVICE, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01First time form 5500 has been submittedYes
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number635612
Policy instance 1
Insurance contract or identification number635612
Number of Individuals Covered217
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $87,796
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $655,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $87,796
Amount paid for insurance broker fees0
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5369808
Policy instance 2
Insurance contract or identification number5369808
Number of Individuals Covered286
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $17,638
Total amount of fees paid to insurance companyUSD $7,826
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $105,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,638
Amount paid for insurance broker fees4122
Additional information about fees paid to insurance brokerTPA ADMIN FEES
Insurance broker organization code?5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number03F7319
Policy instance 1
Insurance contract or identification number03F7319
Number of Individuals Covered197
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $68,504
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,308,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,504
Amount paid for insurance broker fees0
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5369808
Policy instance 2
Insurance contract or identification number5369808
Number of Individuals Covered265
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $21,014
Total amount of fees paid to insurance companyUSD $7,681
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $126,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,014
Amount paid for insurance broker fees4898
Additional information about fees paid to insurance brokerTPA ADMINISTRATION FEES
Insurance broker organization code?3

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