401k Plan data: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN plan

PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 401k Plan overview

Plan Name	PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN
Plan identification number	001

PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

PEACH STATE ROOFING has sponsored the creation of one or more 401k plans.

Company Name: PEACH STATE ROOFING

Employer identification number (EIN): 581920786

NAIC Classification: 238100

Additional information about PEACH STATE ROOFING

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2001-01-05

Company Identification Number: 0013646006

Legal Registered Office Address: 1655 SPECTRUM DR STE A

LAWRENCEVILLE
United States of America (USA)
30043

More information about PEACH STATE ROOFING

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MR. MARTIN KELLY 2023-10-13 MR. MARTIN KELLY 2023-10-13
001 2021-01-01 MR. MARTIN KELLY 2022-10-04 MR. MARTIN KELLY 2022-10-04
001 2020-01-01 MR. MARTIN KELLY 2021-10-08 MR. MARTIN KELLY 2021-10-08
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 MARTIN KELLY 2015-07-31
001 2013-01-01 MARTIN KELLY
001 2012-01-01 MARTIN KELLY
001 2011-01-01 MARTIN KELLY
001 2009-01-01 MARTIN KELLY
001 2009-01-01 MARTIN KELLY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	MR. MARTIN KELLY	2023-10-13	MR. MARTIN KELLY	2023-10-13
001	2021-01-01	MR. MARTIN KELLY	2022-10-04	MR. MARTIN KELLY	2022-10-04
001	2020-01-01	MR. MARTIN KELLY	2021-10-08	MR. MARTIN KELLY	2021-10-08
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	MARTIN KELLY	2015-07-31
001	2013-01-01	MARTIN KELLY
001	2012-01-01	MARTIN KELLY
001	2011-01-01	MARTIN KELLY
001	2009-01-01	MARTIN KELLY
001	2009-01-01	MARTIN KELLY

Plan Statistics for PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN

401k plan membership statisitcs for PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN

Measure Date Value
2022: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 113
Number of retired or separated participants receiving benefits 2022-01-01 4
Number of other retired or separated participants entitled to future benefits 2022-01-01 28
Total of all active and inactive participants 2022-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 145
Number of participants with account balances 2022-01-01 93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 114
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 36
Total of all active and inactive participants 2021-01-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 150
Number of participants with account balances 2021-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 117
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 20
Total of all active and inactive participants 2020-01-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 139
Number of participants with account balances 2020-01-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2013: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 91
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 95
Number of participants with account balances 2013-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 253
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 186
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 7
Total of all active and inactive participants 2012-01-01 193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 193
Number of participants with account balances 2012-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 235
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 220
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 7
Total of all active and inactive participants 2011-01-01 227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 227
Number of participants with account balances 2011-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2009: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 222
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 191
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 191
Total participants 2009-01-01 191
Number of participants with account balances 2009-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	113
Number of retired or separated participants receiving benefits	2022-01-01	4
Number of other retired or separated participants entitled to future benefits	2022-01-01	28
Total of all active and inactive participants	2022-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	145
Number of participants with account balances	2022-01-01	93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	114
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	36
Total of all active and inactive participants	2021-01-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	150
Number of participants with account balances	2021-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	117
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	20
Total of all active and inactive participants	2020-01-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	139
Number of participants with account balances	2020-01-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2013: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	91
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	95
Number of participants with account balances	2013-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	186
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	7
Total of all active and inactive participants	2012-01-01	193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	193
Number of participants with account balances	2012-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	235
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	220
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	7
Total of all active and inactive participants	2011-01-01	227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	227
Number of participants with account balances	2011-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2009: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	222
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	191
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	191
Total participants	2009-01-01	191
Number of participants with account balances	2009-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN

Measure	Date	Value
2022 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-935,580
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$407,856
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$402,757
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$773,284
Value of total assets at end of year	2022-12-31	$6,892,290
Value of total assets at beginning of year	2022-12-31	$8,235,726
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$5,099
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$500,022
Participant contributions at end of year	2022-12-31	$23,508
Participant contributions at beginning of year	2022-12-31	$15,324
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-1,343,436
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$6,892,290
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$8,235,726
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$6,851,531
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$8,204,444
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$1,015
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$1,015
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,708,864
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$273,262
Employer contributions (assets) at end of year	2022-12-31	$17,251
Employer contributions (assets) at beginning of year	2022-12-31	$14,943
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$402,757
Contract administrator fees	2022-12-31	$5,099
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MARSHALL JONES
Accountancy firm EIN	2022-12-31	581589807
2021 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,689,924
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$300,308
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$300,308
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$704,400
Value of total assets at end of year	2021-12-31	$8,235,726
Value of total assets at beginning of year	2021-12-31	$6,846,110
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$0
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$458,386
Participant contributions at end of year	2021-12-31	$15,324
Participant contributions at beginning of year	2021-12-31	$11,774
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$1,389,616
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$8,235,726
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$6,846,110
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$8,204,444
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$6,810,998
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$1,015
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$27
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$27
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$985,524
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$246,014
Employer contributions (assets) at end of year	2021-12-31	$14,943
Employer contributions (assets) at beginning of year	2021-12-31	$23,311
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$300,308
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MARSHALL JONES
Accountancy firm EIN	2021-12-31	581589807
2020 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$1,028,099
Total unrealized appreciation/depreciation of assets	2020-12-31	$1,028,099
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,664,751
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$13,909
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$13,909
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$636,652
Value of total assets at end of year	2020-12-31	$6,846,110
Value of total assets at beginning of year	2020-12-31	$5,195,268
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$0
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$398,702
Participant contributions at end of year	2020-12-31	$11,774
Participant contributions at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$1,650,842
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$6,846,110
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,195,268
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$6,810,998
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$5,178,881
Value of interest in master investment trust accounts at end of year	2020-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$27
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$27
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$27
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$237,950
Employer contributions (assets) at end of year	2020-12-31	$23,311
Employer contributions (assets) at beginning of year	2020-12-31	$16,360
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$13,909
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MARSHALL JONES
Accountancy firm EIN	2020-12-31	581589807
2013 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$603,730
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$21,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$21,432
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$227,376
Value of total assets at end of year	2013-12-31	$2,409,378
Value of total assets at beginning of year	2013-12-31	$1,827,355
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$275
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$133,022
Participant contributions at end of year	2013-12-31	$50
Participant contributions at beginning of year	2013-12-31	$3,506
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$12,898
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$582,023
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,409,378
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,827,355
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$1,938,720
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$1,383,816
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$454,298
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$431,847
Net investment gain/loss from pooled separate accounts	2013-12-31	$376,354
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$81,456
Employer contributions (assets) at end of year	2013-12-31	$16,310
Employer contributions (assets) at beginning of year	2013-12-31	$8,186
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$21,432
Contract administrator fees	2013-12-31	$275
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	MARSHALL JONES
Accountancy firm EIN	2013-12-31	581589807
2012 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$393,434
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$58,061
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$57,711
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$222,807
Value of total assets at end of year	2012-12-31	$1,827,355
Value of total assets at beginning of year	2012-12-31	$1,491,982
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$350
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$120,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$147,673
Participant contributions at end of year	2012-12-31	$3,506
Participant contributions at beginning of year	2012-12-31	$3,043
Other income not declared elsewhere	2012-12-31	$2,207
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$335,373
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,827,355
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,491,982
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$1,383,816
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$1,468,627
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$431,847
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$18,490
Net investment gain/loss from pooled separate accounts	2012-12-31	$168,420
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$75,134
Employer contributions (assets) at end of year	2012-12-31	$8,186
Employer contributions (assets) at beginning of year	2012-12-31	$1,822
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$57,711
Contract administrator fees	2012-12-31	$350
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	MOORE COLSON
Accountancy firm EIN	2012-12-31	581653941
2011 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$177,997
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$9,238
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$9,238
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$222,697
Value of total assets at end of year	2011-12-31	$1,491,982
Value of total assets at beginning of year	2011-12-31	$1,323,223
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$120,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$148,648
Participant contributions at end of year	2011-12-31	$3,043
Participant contributions at beginning of year	2011-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$168,759
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,491,982
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,323,223
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$1,468,627
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$1,308,634
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$18,490
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$14,589
Net investment gain/loss from pooled separate accounts	2011-12-31	$-44,700
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$74,049
Employer contributions (assets) at end of year	2011-12-31	$1,822
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$9,238
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	MARSHALL JONES CPA & ADVISORS
Accountancy firm EIN	2011-12-31	581589807
2010 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$298,473
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$15,404
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$15,254
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$204,617
Value of total assets at end of year	2010-12-31	$1,323,223
Value of total assets at beginning of year	2010-12-31	$1,040,154
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$150
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$100,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$135,437
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Total non interest bearing cash at end of year	2010-12-31	$0
Total non interest bearing cash at beginning of year	2010-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$283,069
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,323,223
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,040,154
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$0
Value of interest in pooled separate accounts at end of year	2010-12-31	$1,308,634
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$1,028,422
Interest on participant loans	2010-12-31	$0
Value of interest in common/collective trusts at end of year	2010-12-31	$0
Value of interest in common/collective trusts at beginning of year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$14,589
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$11,732
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$93,856
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$69,180
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$15,254
Contract administrator fees	2010-12-31	$150
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$0
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	MARSHALL JONES CPA & ADVISORS
Accountancy firm EIN	2010-12-31	581589807
2009 : PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN

2022: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2013: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PEACH STATE ROOFING, INC. 401(K) AND PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114491

Policy instance

Insurance contract or identification number	114491
Number of Individuals Covered	105
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $35,783
Total amount of fees paid to insurance company	USD $8,086
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,783
Insurance broker organization code?	3
Amount paid for insurance broker fees	8086
Additional information about fees paid to insurance broker	RECORD KEEPING

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114491

Policy instance

Insurance contract or identification number	114491
Number of Individuals Covered	96
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $36,966
Total amount of fees paid to insurance company	USD $4,304
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,966
Insurance broker organization code?	3
Amount paid for insurance broker fees	4304
Additional information about fees paid to insurance broker	RECORD KEEPING

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114491

Policy instance

Insurance contract or identification number	114491
Number of Individuals Covered	94
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $27,440
Total amount of fees paid to insurance company	USD $3,150
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,440
Insurance broker organization code?	3
Amount paid for insurance broker fees	3150
Additional information about fees paid to insurance broker	RECORD KEEPING

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

873059

Policy instance

Insurance contract or identification number	873059
Number of Individuals Covered	34
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,289
Total amount of fees paid to insurance company	USD $822
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,289
Insurance broker organization code?	3
Amount paid for insurance broker fees	822
Additional information about fees paid to insurance broker	RECORD KEEPING
Insurance broker name	THE RETIREMENT ADVANTAGE

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

873059

Policy instance

Insurance contract or identification number	873059
Number of Individuals Covered	36
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,221
Total amount of fees paid to insurance company	USD $797
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,221
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	THE RETIREMENT ADVANTAGE

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHP444

Policy instance

Insurance contract or identification number	PHP444
Number of Individuals Covered	36
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,140
Total amount of fees paid to insurance company	USD $695
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHP444

Policy instance

Insurance contract or identification number	PHP444
Number of Individuals Covered	36
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,649
Total amount of fees paid to insurance company	USD $543
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	PEACH STATE ROOFING
Employer identification number (EIN):	581920786
NAIC Classification:	238100

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2001-01-05
Company Identification Number:	0013646006
Legal Registered Office Address:	1655 SPECTRUM DR STE A LAWRENCEVILLE United States of America (USA) 30043