401k Plan data: SPRAGGINS INC., EMPLOYEE BENEFITS PLAN plan

SPRAGGINS INC., EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	SPRAGGINS INC., EMPLOYEE BENEFITS PLAN
Plan identification number	501

SPRAGGINS INC., EMPLOYEE BENEFITS 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) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name: SPRAGGINS FLOORING, INC.

Employer identification number (EIN): 591810546

NAIC Classification: 442210
NAIC Description: Floor Covering Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPRAGGINS INC., EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 TRAVIS JOHNSON 2024-07-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	TRAVIS JOHNSON	2024-07-25

Form 5500 Responses for SPRAGGINS INC., EMPLOYEE BENEFITS PLAN

2023: SPRAGGINS INC., EMPLOYEE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

635156

Policy instance

Insurance contract or identification number	635156
Number of Individuals Covered	101
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $56,359
Total amount of fees paid to insurance company	USD $11,830
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $358,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5399316

Policy instance

Insurance contract or identification number	5399316
Number of Individuals Covered	168
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,172
Total amount of fees paid to insurance company	USD $777
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $59,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

45249

Policy instance

Insurance contract or identification number	45249
Number of Individuals Covered	22
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,186
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $20,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SPRAGGINS FLOORING, INC.
Employer identification number (EIN):	591810546
NAIC Classification:	442210
NAIC Description:	Floor Covering Stores