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| Plan Name | CAROTEK, INC. HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CAROTEK, INC. |
| Employer identification number (EIN): | 561712853 |
| NAIC Classification: | 811310 |
| NAIC Description: | Commercial and Industrial Machinery and Equipment (except Automotive and Electronic) Repair and Maintenance |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2023-11-01 | MARY ARGENAS | |||
| 505 | 2022-11-01 | ||||
| 505 | 2022-11-01 | MARY ARGENAS |
| 2022: CAROTEK, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-11-01 | Type of plan entity | Single employer plan |
| 2022-11-01 | First time form 5500 has been submitted | Yes |
| 2022-11-01 | Submission has been amended | No |
| 2022-11-01 | This submission is the final filing | No |
| 2022-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-11-01 | Plan is a collectively bargained plan | No |
| 2022-11-01 | Plan funding arrangement – Insurance | Yes |
| 2022-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 14159114-1001 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |
| Policy contract number | 50037405 |
| Policy instance | 2 |
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