401k Plan data: NORTHROCK, INC WELFARE BEENFIT PLAN plan

NORTHROCK, INC WELFARE BEENFIT PLAN 401k Plan overview

Plan Name	NORTHROCK, INC WELFARE BEENFIT PLAN
Plan identification number	501

NORTHROCK, INC WELFARE BEENFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: NORTHROCK, INC.

Employer identification number (EIN): 481145585

NAIC Classification: 531390
NAIC Description: Other Activities Related to Real Estate

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHROCK, INC WELFARE BEENFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-09-01 CHRIS THOMAS 2024-02-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-09-01	CHRIS THOMAS	2024-02-22

Plan Statistics for NORTHROCK, INC WELFARE BEENFIT PLAN

401k plan membership statisitcs for NORTHROCK, INC WELFARE BEENFIT PLAN

Measure Date Value
2022: NORTHROCK, INC WELFARE BEENFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-09-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-09-01 110
Number of retired or separated participants receiving benefits 2022-09-01 0
Number of other retired or separated participants entitled to future benefits 2022-09-01 0
Total of all active and inactive participants 2022-09-01 110
Number of employers contributing to the scheme 2022-09-01 0

Measure	Date	Value
2022: NORTHROCK, INC WELFARE BEENFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-09-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-09-01	110
Number of retired or separated participants receiving benefits	2022-09-01	0
Number of other retired or separated participants entitled to future benefits	2022-09-01	0
Total of all active and inactive participants	2022-09-01	110
Number of employers contributing to the scheme	2022-09-01	0

Form 5500 Responses for NORTHROCK, INC WELFARE BEENFIT PLAN

2022: NORTHROCK, INC WELFARE BEENFIT PLAN 2022 form 5500 responses
2022-09-01	Type of plan entity	Single employer plan
2022-09-01	First time form 5500 has been submitted	Yes
2022-09-01	Plan funding arrangement – Insurance	Yes
2022-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-09-01	Plan benefit arrangement – Insurance	Yes
2022-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

27012

Policy instance

Insurance contract or identification number	27012
Number of Individuals Covered	82
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $20,870
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,870
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

53042

Policy instance

Insurance contract or identification number	53042
Number of Individuals Covered	59
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $2,360
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $1,995
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30059889

Policy instance

Insurance contract or identification number	30059889
Number of Individuals Covered	42
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $804
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $549
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

857176G

Policy instance

Insurance contract or identification number	857176G
Number of Individuals Covered	99
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $1,132
Total amount of fees paid to insurance company	USD $185
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $749
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

EMPAC INC (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	110
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NORTHROCK, INC.
Employer identification number (EIN):	481145585
NAIC Classification:	531390
NAIC Description:	Other Activities Related to Real Estate