401k Plan data: CARDINAL CARRYOR WELFARE BENEFIT PLAN plan

CARDINAL CARRYOR WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CARDINAL CARRYOR WELFARE BENEFIT PLAN
Plan identification number	501

CARDINAL CARRYOR WELFARE BENEFIT PLAN Benefits

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

CARDINAL CARRYOR, INC. has sponsored the creation of one or more 401k plans.

Company Name: CARDINAL CARRYOR, INC.

Employer identification number (EIN): 610488546

NAIC Classification: 423990
NAIC Description: Other Miscellaneous Durable Goods Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARDINAL CARRYOR WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01 COURTNEY BURFORD 2023-04-19
501 2020-10-01 COURTNEY BURFORD 2022-05-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-10-01	COURTNEY BURFORD	2023-04-19
501	2020-10-01	COURTNEY BURFORD	2022-05-03

Plan Statistics for CARDINAL CARRYOR WELFARE BENEFIT PLAN

401k plan membership statisitcs for CARDINAL CARRYOR WELFARE BENEFIT PLAN

Measure Date Value
2021: CARDINAL CARRYOR WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 138
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 98
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 98
Number of employers contributing to the scheme 2021-10-01 0
2020: CARDINAL CARRYOR WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 100
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 138
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 138
Number of employers contributing to the scheme 2020-10-01 0

Measure	Date	Value
2021: CARDINAL CARRYOR WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	138
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	98
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	98
Number of employers contributing to the scheme	2021-10-01	0
2020: CARDINAL CARRYOR WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	100
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	138
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	138
Number of employers contributing to the scheme	2020-10-01	0

Form 5500 Responses for CARDINAL CARRYOR WELFARE BENEFIT PLAN

2021: CARDINAL CARRYOR WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: CARDINAL CARRYOR WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	First time form 5500 has been submitted	Yes
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

169383

Policy instance

Insurance contract or identification number	169383
Number of Individuals Covered	149
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $24,435
Total amount of fees paid to insurance company	USD $6,700
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL,ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $122,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,435
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

549588

Policy instance

Insurance contract or identification number	549588
Number of Individuals Covered	79
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $7,720
Total amount of fees paid to insurance company	USD $4,279
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $59,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,720
Amount paid for insurance broker fees	4279
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017751-00

Policy instance

Insurance contract or identification number	01-017751-00
Number of Individuals Covered	138
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $8,497
Total amount of fees paid to insurance company	USD $462
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $56,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,497
Amount paid for insurance broker fees	462
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	CARDINAL CARRYOR, INC.
Employer identification number (EIN):	610488546
NAIC Classification:	423990
NAIC Description:	Other Miscellaneous Durable Goods Merchant Wholesalers