401k Plan data: UNITED ROTARY BRUSH GROUP BENEFIT PLAN plan

UNITED ROTARY BRUSH GROUP BENEFIT PLAN 401k Plan overview

Plan Name	UNITED ROTARY BRUSH GROUP BENEFIT PLAN
Plan identification number	501

UNITED ROTARY BRUSH GROUP BENEFIT PLAN Benefits

401k Plan Type	Welfare 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) Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

UNITED ROTARY BRUSH CORP. has sponsored the creation of one or more 401k plans.

Company Name: UNITED ROTARY BRUSH CORP.

Employer identification number (EIN): 480945667

NAIC Classification: 339900

Additional information about UNITED ROTARY BRUSH CORP.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2017-06-30

Company Identification Number: 0802758732

Legal Registered Office Address: 510 W FRONTIER LN

OLATHE
United States of America (USA)
66061

More information about UNITED ROTARY BRUSH CORP.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNITED ROTARY BRUSH GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 CINDY BRAY 2024-01-23
501 2022-01-01 CINDY BRAY 2023-07-10
501 2021-01-01 CINDY BRAY 2023-03-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	CINDY BRAY	2024-01-23
501	2022-01-01	CINDY BRAY	2023-07-10
501	2021-01-01	CINDY BRAY	2023-03-22

Form 5500 Responses for UNITED ROTARY BRUSH GROUP BENEFIT PLAN

2023: UNITED ROTARY BRUSH GROUP BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: UNITED ROTARY BRUSH GROUP BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: UNITED ROTARY BRUSH GROUP BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

37492

Policy instance

Insurance contract or identification number	37492
Number of Individuals Covered	173
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $14,608
Total amount of fees paid to insurance company	USD $2,351
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $140,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

633061

Policy instance

Insurance contract or identification number	633061
Number of Individuals Covered	163
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $57,403
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $445,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

247071

Policy instance

Insurance contract or identification number	247071
Number of Individuals Covered	50
Insurance policy start date	2022-01-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $574
Total amount of fees paid to insurance company	USD $831
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $35,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

633061

Policy instance

Insurance contract or identification number	633061
Number of Individuals Covered	159
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $53,495
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $449,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

51961

Policy instance

Insurance contract or identification number	51961
Number of Individuals Covered	118
Insurance policy start date	2022-01-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $2,644
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98286661001

Policy instance

Insurance contract or identification number	98286661001
Number of Individuals Covered	173
Insurance policy start date	2022-01-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $562
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

247071

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

633061

Policy instance

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

51961

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98286661001

Policy instance

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

33661000

Policy instance

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Company Name:	UNITED ROTARY BRUSH CORP.
Employer identification number (EIN):	480945667
NAIC Classification:	339900

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2017-06-30
Company Identification Number:	0802758732
Legal Registered Office Address:	510 W FRONTIER LN OLATHE United States of America (USA) 66061