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CODY POOLS INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameCODY POOLS INC. HEALTH AND WELFARE PLAN
Plan identification number 501

CODY POOLS 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)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

CODY POOLS, INC. has sponsored the creation of one or more 401k plans.

Company Name:CODY POOLS, INC.
Employer identification number (EIN):208907120
NAIC Classification:238900

Additional information about CODY POOLS, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2007-04-26
Company Identification Number: 0800807609
Legal Registered Office Address: 101 E OLD SETTLERS BLVD STE 200

ROUND ROCK
United States of America (USA)
78664

More information about CODY POOLS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CODY POOLS INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-10-01AREFA HUSSAIN2023-07-14
5012021-10-01AREFA HUSSAIN2023-06-26
5012020-10-01AREFA HUSSAIN2022-08-19

Plan Statistics for CODY POOLS INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for CODY POOLS INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: CODY POOLS INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-10-01214
Total number of active participants reported on line 7a of the Form 55002022-10-01362
Number of retired or separated participants receiving benefits2022-10-010
Number of other retired or separated participants entitled to future benefits2022-10-010
Total of all active and inactive participants2022-10-01362
Number of employers contributing to the scheme2022-10-010
2021: CODY POOLS INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01158
Total number of active participants reported on line 7a of the Form 55002021-10-01158
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01158
Number of employers contributing to the scheme2021-10-010
2020: CODY POOLS INC. HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01106
Total number of active participants reported on line 7a of the Form 55002020-10-01165
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01165
Number of employers contributing to the scheme2020-10-010

Form 5500 Responses for CODY POOLS INC. HEALTH AND WELFARE PLAN

2022: CODY POOLS INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-10-01Type of plan entitySingle employer plan
2022-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-10-01Plan funding arrangement – InsuranceYes
2022-10-01Plan benefit arrangement – InsuranceYes
2021: CODY POOLS INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: CODY POOLS INC. HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01First time form 5500 has been submittedYes
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number149082
Policy instance 1
Insurance contract or identification number149082
Number of Individuals Covered538
Insurance policy start date2022-10-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $22,465
Total amount of fees paid to insurance companyUSD $140
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $415,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,465
Amount paid for insurance broker fees140
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number40770
Policy instance 2
Insurance contract or identification number40770
Number of Individuals Covered362
Insurance policy start date2022-10-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $32,876
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $170,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,695
Amount paid for insurance broker fees0
Insurance broker organization code?3
BANNER HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16058 )
Policy contract number149082
Policy instance 3
Insurance contract or identification number149082
Number of Individuals Covered51
Insurance policy start date2022-10-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number247420
Policy instance 1
Insurance contract or identification number247420
Number of Individuals Covered371
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $58,130
Total amount of fees paid to insurance companyUSD $999
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,675,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $28,651
Amount paid for insurance broker fees999
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number247420
Policy instance 1
Insurance contract or identification number247420
Number of Individuals Covered165
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $34,283
Total amount of fees paid to insurance companyUSD $1,116
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $897,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $34,283
Amount paid for insurance broker fees1116
Additional information about fees paid to insurance brokerOTHER COMMISSIONS, SPECIAL PROGRAMS
Insurance broker organization code?3

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