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CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameCERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 502

CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

CERTIFIED CARPET SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:CERTIFIED CARPET SERVICES, INC.
Employer identification number (EIN):231630052
NAIC Classification:442210
NAIC Description:Floor Covering Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-12-01
5022020-12-01

Plan Statistics for CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0117
Total number of active participants reported on line 7a of the Form 55002022-01-0111
Number of retired or separated participants receiving benefits2022-01-015
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0116
2021: CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-0133
Total number of active participants reported on line 7a of the Form 55002021-12-0130
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-0130
2020: CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-0130
Total number of active participants reported on line 7a of the Form 55002020-12-0132
Number of retired or separated participants receiving benefits2020-12-011
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-0133

Financial Data on CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022 : CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$11,586
Total plan liabilities at beginning of year2022-12-31$35,007
Total income from all sources2022-12-31$226,818
Expenses. Total of all expenses incurred2022-12-31$222,711
Benefits paid (including direct rollovers)2022-12-31$116,875
Total plan assets at end of year2022-12-31$6,742
Total plan assets at beginning of year2022-12-31$26,056
Value of fidelity bond covering the plan2022-12-31$500,000
Total contributions received or receivable from participants2022-12-31$33,575
Expenses. Other expenses not covered elsewhere2022-12-31$103,388
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$23
Net income (gross income less expenses)2022-12-31$4,107
Net plan assets at end of year (total assets less liabilities)2022-12-31$-4,844
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$-8,951
Total contributions received or receivable from employer(s)2022-12-31$193,220
Value of corrective distributions2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$2,448
2021 : CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$35,007
Total plan liabilities at beginning of year2021-12-31$36,549
Total income from all sources2021-12-31$24,709
Expenses. Total of all expenses incurred2021-12-31$23,710
Benefits paid (including direct rollovers)2021-12-31$9,577
Total plan assets at end of year2021-12-31$26,056
Total plan assets at beginning of year2021-12-31$26,599
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$3,750
Expenses. Other expenses not covered elsewhere2021-12-31$13,461
Contributions received from other sources (not participants or employers)2021-12-31$295
Other income received2021-12-31$3
Net income (gross income less expenses)2021-12-31$999
Net plan assets at end of year (total assets less liabilities)2021-12-31$-8,951
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$-9,950
Total contributions received or receivable from employer(s)2021-12-31$20,661
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$672
Total plan liabilities at end of year2021-11-30$36,549
Total income from all sources2021-11-30$236,642
Expenses. Total of all expenses incurred2021-11-30$246,592
Benefits paid (including direct rollovers)2021-11-30$119,978
Total plan assets at end of year2021-11-30$26,599
Value of fidelity bond covering the plan2021-11-30$500,000
Total contributions received or receivable from participants2021-11-30$38,625
Expenses. Other expenses not covered elsewhere2021-11-30$118,168
Contributions received from other sources (not participants or employers)2021-11-30$13,730
Other income received2021-11-30$32
Net income (gross income less expenses)2021-11-30$-9,950
Net plan assets at end of year (total assets less liabilities)2021-11-30$-9,950
Net plan assets at beginning of year (total assets less liabilities)2021-11-30$0
Total contributions received or receivable from employer(s)2021-11-30$184,255
Expenses. Administrative service providers (salaries,fees and commissions)2021-11-30$8,446

Form 5500 Responses for CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN

2022: CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT 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
2021: CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement - TrustYes
2021-12-01Plan benefit arrangement – General assets of the sponsorYes
2020: CERTIFIED CARPET SERVICES, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01First time form 5500 has been submittedYes
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes
2020-12-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500646
Policy instance 1
Insurance contract or identification number30500646
Number of Individuals Covered22
Insurance policy start date2022-12-01
Insurance policy end date2022-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $82,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500646
Policy instance 1
Insurance contract or identification number30500646
Number of Individuals Covered25
Insurance policy start date2021-12-01
Insurance policy end date2021-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number45328
Policy instance 2
Insurance contract or identification number45328
Number of Individuals Covered30
Insurance policy start date2021-12-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $22
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?1
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500646
Policy instance 1
Insurance contract or identification number30500646
Number of Individuals Covered27
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $81,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number45328
Policy instance 2
Insurance contract or identification number45328
Number of Individuals Covered32
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $282
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $1,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $282
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?1

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