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ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN 401k Plan overview

Plan NameARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN
Plan identification number 501

ARCHITECTURAL SURFACES GROUP, LLC HEALTH & 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)

401k Sponsoring company profile

ARCHITECTURAL SURFACES GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name:ARCHITECTURAL SURFACES GROUP, LLC
Employer identification number (EIN):474228240
NAIC Classification:423990
NAIC Description:Other Miscellaneous Durable Goods Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01SCOTT JARVIS2023-08-01
5012021-07-01LISA GOULD2022-08-24

Plan Statistics for ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN

401k plan membership statisitcs for ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN

Measure Date Value
2022: ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01320
Total number of active participants reported on line 7a of the Form 55002022-01-01492
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01492
Number of employers contributing to the scheme2022-01-010
2021: ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01368
Total number of active participants reported on line 7a of the Form 55002021-07-01320
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01320
Number of employers contributing to the scheme2021-07-010

Form 5500 Responses for ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN

2022: ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ARCHITECTURAL SURFACES GROUP, LLC HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01First time form 5500 has been submittedYes
2021-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberL04706
Policy instance 1
Insurance contract or identification numberL04706
Number of Individuals Covered533
Insurance policy start date2022-01-01
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 $4,095,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number22291
Policy instance 2
Insurance contract or identification number22291
Number of Individuals Covered492
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $106,620
Total amount of fees paid to insurance companyUSD $6,783
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, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $478,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,223
Amount paid for insurance broker fees5681
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberL03230
Policy instance 1
Insurance contract or identification numberL03230
Number of Individuals Covered418
Insurance policy start date2021-07-01
Insurance policy end date2021-12-31
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 $1,513,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number22291
Policy instance 2
Insurance contract or identification number22291
Number of Individuals Covered332
Insurance policy start date2021-07-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $19,353
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, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $139,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,125
Amount paid for insurance broker fees0
Insurance broker organization code?3

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