401k Plan data: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN plan

OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	OLDCASTLE SURFACES HEALTH AND WELFARE PLAN
Plan identification number	501

OLDCASTLE SURFACES HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

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

Company Name: OLDCASTLE SURFACES, INC.

Employer identification number (EIN): 581604565

NAIC Classification: 327900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OLDCASTLE SURFACES HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-03-01 MARLENE WHITFIELD
501 2014-02-01 MARLENE WHITFIELD
501 2013-02-01 MARLENE WHITFIELD
501 2012-02-01 MARLENE WHITFIELD
501 2011-02-01 MARLENE WHITFIELD
501 2010-02-01 MARLENE WHITFIELD
501 2008-02-01 MARLENE WHITFIELD
501 2007-02-01 MARLENE WHITFIELD

Plan id#	Filing Submission Date	Name of Administrator
501	2014-03-01	MARLENE WHITFIELD
501	2014-02-01	MARLENE WHITFIELD
501	2013-02-01	MARLENE WHITFIELD
501	2012-02-01	MARLENE WHITFIELD
501	2011-02-01	MARLENE WHITFIELD
501	2010-02-01	MARLENE WHITFIELD
501	2008-02-01	MARLENE WHITFIELD
501	2007-02-01	MARLENE WHITFIELD

Plan Statistics for OLDCASTLE SURFACES HEALTH AND WELFARE PLAN

401k plan membership statisitcs for OLDCASTLE SURFACES HEALTH AND WELFARE PLAN

Measure Date Value
2014: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-03-01 155
Total number of active participants reported on line 7a of the Form 5500 2014-03-01 208
Number of retired or separated participants receiving benefits 2014-03-01 0
Number of other retired or separated participants entitled to future benefits 2014-03-01 0
Total of all active and inactive participants 2014-03-01 208
Total participants, beginning-of-year 2014-02-01 103
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 155
Number of retired or separated participants receiving benefits 2014-02-01 0
Number of other retired or separated participants entitled to future benefits 2014-02-01 0
Total of all active and inactive participants 2014-02-01 155
2013: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-02-01 103
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 103
Number of retired or separated participants receiving benefits 2013-02-01 0
Number of other retired or separated participants entitled to future benefits 2013-02-01 0
Total of all active and inactive participants 2013-02-01 103
2012: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 238
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 103
Number of retired or separated participants receiving benefits 2012-02-01 0
Number of other retired or separated participants entitled to future benefits 2012-02-01 0
Total of all active and inactive participants 2012-02-01 103
2011: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 109
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 238
Number of retired or separated participants receiving benefits 2011-02-01 0
Number of other retired or separated participants entitled to future benefits 2011-02-01 0
Total of all active and inactive participants 2011-02-01 238
2010: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-02-01 384
Total number of active participants reported on line 7a of the Form 5500 2010-02-01 109
Number of retired or separated participants receiving benefits 2010-02-01 0
Number of other retired or separated participants entitled to future benefits 2010-02-01 0
Total of all active and inactive participants 2010-02-01 109
2008: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year 2008-02-01 142
Total number of active participants reported on line 7a of the Form 5500 2008-02-01 249
Number of retired or separated participants receiving benefits 2008-02-01 0
Number of other retired or separated participants entitled to future benefits 2008-02-01 0
Total of all active and inactive participants 2008-02-01 249
2007: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year 2007-02-01 142
Total number of active participants reported on line 7a of the Form 5500 2007-02-01 142
Number of retired or separated participants receiving benefits 2007-02-01 0
Number of other retired or separated participants entitled to future benefits 2007-02-01 0
Total of all active and inactive participants 2007-02-01 142

Measure	Date	Value
2014: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-03-01	155
Total number of active participants reported on line 7a of the Form 5500	2014-03-01	208
Number of retired or separated participants receiving benefits	2014-03-01	0
Number of other retired or separated participants entitled to future benefits	2014-03-01	0
Total of all active and inactive participants	2014-03-01	208
Total participants, beginning-of-year	2014-02-01	103
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	155
Number of retired or separated participants receiving benefits	2014-02-01	0
Number of other retired or separated participants entitled to future benefits	2014-02-01	0
Total of all active and inactive participants	2014-02-01	155
2013: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	103
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	103
Number of retired or separated participants receiving benefits	2013-02-01	0
Number of other retired or separated participants entitled to future benefits	2013-02-01	0
Total of all active and inactive participants	2013-02-01	103
2012: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	238
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	103
Number of retired or separated participants receiving benefits	2012-02-01	0
Number of other retired or separated participants entitled to future benefits	2012-02-01	0
Total of all active and inactive participants	2012-02-01	103
2011: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	109
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	238
Number of retired or separated participants receiving benefits	2011-02-01	0
Number of other retired or separated participants entitled to future benefits	2011-02-01	0
Total of all active and inactive participants	2011-02-01	238
2010: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-02-01	384
Total number of active participants reported on line 7a of the Form 5500	2010-02-01	109
Number of retired or separated participants receiving benefits	2010-02-01	0
Number of other retired or separated participants entitled to future benefits	2010-02-01	0
Total of all active and inactive participants	2010-02-01	109
2008: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year	2008-02-01	142
Total number of active participants reported on line 7a of the Form 5500	2008-02-01	249
Number of retired or separated participants receiving benefits	2008-02-01	0
Number of other retired or separated participants entitled to future benefits	2008-02-01	0
Total of all active and inactive participants	2008-02-01	249
2007: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year	2007-02-01	142
Total number of active participants reported on line 7a of the Form 5500	2007-02-01	142
Number of retired or separated participants receiving benefits	2007-02-01	0
Number of other retired or separated participants entitled to future benefits	2007-02-01	0
Total of all active and inactive participants	2007-02-01	142

Form 5500 Responses for OLDCASTLE SURFACES HEALTH AND WELFARE PLAN

2014: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-03-01	Type of plan entity	Single employer plan
2014-03-01	Submission has been amended	No
2014-03-01	This submission is the final filing	No
2014-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-03-01	Plan is a collectively bargained plan	No
2014-03-01	Plan funding arrangement – Insurance	Yes
2014-03-01	Plan benefit arrangement – Insurance	Yes
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	Submission has been amended	No
2014-02-01	This submission is the final filing	No
2014-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-02-01	Plan is a collectively bargained plan	No
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2013: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Submission has been amended	No
2013-02-01	This submission is the final filing	No
2013-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-02-01	Plan is a collectively bargained plan	No
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes
2012: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	No
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2011: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes
2010: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2010 form 5500 responses
2010-02-01	Type of plan entity	Single employer plan
2010-02-01	Submission has been amended	No
2010-02-01	This submission is the final filing	No
2010-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-02-01	Plan is a collectively bargained plan	No
2010-02-01	Plan funding arrangement – Insurance	Yes
2010-02-01	Plan benefit arrangement – Insurance	Yes
2008: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2008 form 5500 responses
2008-02-01	Type of plan entity	Single employer plan
2008-02-01	Submission has been amended	No
2008-02-01	This submission is the final filing	No
2008-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-02-01	Plan is a collectively bargained plan	No
2008-02-01	Plan funding arrangement – Insurance	Yes
2008-02-01	Plan benefit arrangement – Insurance	Yes
2007: OLDCASTLE SURFACES HEALTH AND WELFARE PLAN 2007 form 5500 responses
2007-02-01	Type of plan entity	Single employer plan
2007-02-01	First time form 5500 has been submitted	Yes
2007-02-01	Submission has been amended	No
2007-02-01	This submission is the final filing	No
2007-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-02-01	Plan is a collectively bargained plan	No
2007-02-01	Plan funding arrangement – Insurance	Yes
2007-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E7794282
Policy instance	3
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	652127/GA8176
Policy instance	1
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA2650
Policy instance	2
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	837623
Policy instance	4
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	716412
Policy instance	1
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	576873
Policy instance	2
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E7794282
Policy instance	3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	716412
Policy instance	1
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	576873
Policy instance	2
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E7794282
Policy instance	3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0716412
Policy instance	1
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E7794282
Policy instance	3
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	576873
Policy instance	2
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	576873
Policy instance	2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	716412
Policy instance	1
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E7794282
Policy instance	3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05731207
Policy instance	2
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E7794282
Policy instance	3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	716412
Policy instance	1
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E7794282
Policy instance	3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05731207
Policy instance	2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	716412
Policy instance	1

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Company Name:	OLDCASTLE SURFACES, INC.
Employer identification number (EIN):	581604565
NAIC Classification:	327900