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| Plan Name | PELLA CAROLINA, INC. HEALTH BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PELLA CAROLINA, INC. |
| Employer identification number (EIN): | 562280814 |
| NAIC Classification: | 327210 |
Additional information about PELLA CAROLINA, INC.
| Jurisdiction of Incorporation: | Virginia Secretary of State |
| Incorporation Date: | 2002-01-25 |
| Company Identification Number: | F149760 |
| Legal Registered Office Address: |
4701 Cox Rd Ste 285 Glen Allen United States of America (USA) 23060-6808 |
More information about PELLA CAROLINA, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2024-05-01 | ED YATES | |||
| 501 | 2023-05-01 | ||||
| 501 | 2023-05-01 | EDWARD YATES | |||
| 501 | 2022-05-01 | ||||
| 501 | 2022-05-01 | ED YATES | |||
| 501 | 2021-05-01 | ||||
| 501 | 2021-05-01 | MELISSA COFFER |
| 2023: PELLA CAROLINA, INC. HEALTH BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-05-01 | Type of plan entity | Single employer plan |
| 2023-05-01 | Submission has been amended | No |
| 2023-05-01 | This submission is the final filing | No |
| 2023-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-05-01 | Plan is a collectively bargained plan | No |
| 2023-05-01 | Plan funding arrangement – Insurance | Yes |
| 2023-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: PELLA CAROLINA, INC. HEALTH BENEFIT PLAN 2022 form 5500 responses | ||
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Submission has been amended | No |
| 2022-05-01 | This submission is the final filing | No |
| 2022-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-05-01 | Plan is a collectively bargained plan | No |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PELLA CAROLINA, INC. HEALTH BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | First time form 5500 has been submitted | Yes |
| 2021-05-01 | Submission has been amended | No |
| 2021-05-01 | This submission is the final filing | No |
| 2021-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-05-01 | Plan is a collectively bargained plan | No |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | TS05977634 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 038483 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 01-020627-00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 12643000 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 14161463-1001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 14161463-1001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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