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HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 401k Plan overview

Plan NameHARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN
Plan identification number 501

HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare 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

401k Sponsoring company profile

HARNESS ROOFING, INC. has sponsored the creation of one or more 401k plans.

Company Name:HARNESS ROOFING, INC.
Employer identification number (EIN):710654212
NAIC Classification:238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-09-01DONNALEE NICHOLS
5012022-09-01
5012022-09-01DONNALEE NICHOLS
5012021-09-01
5012021-09-01DONNALEE NICHOLS
5012020-09-01
5012020-09-01DONNALEE NICHOLS
5012019-09-01
5012016-09-01HOGANTAYLOR LLP PREPARER
5012015-09-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2017-06-15
5012014-09-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2016-03-28
5012013-09-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2016-01-20
5012012-09-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2016-01-20
5012011-09-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2016-02-03

Plan Statistics for HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN

401k plan membership statisitcs for HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN

Measure Date Value
2022: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-01233
Total number of active participants reported on line 7a of the Form 55002022-09-01275
Total of all active and inactive participants2022-09-01275
2021: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01226
Total number of active participants reported on line 7a of the Form 55002021-09-01233
Total of all active and inactive participants2021-09-01233
2020: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01223
Total number of active participants reported on line 7a of the Form 55002020-09-01226
Total of all active and inactive participants2020-09-01226
2019: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01248
Total number of active participants reported on line 7a of the Form 55002019-09-01222
Number of retired or separated participants receiving benefits2019-09-011
Total of all active and inactive participants2019-09-01223
2016: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01142
Total number of active participants reported on line 7a of the Form 55002016-09-01191
Total of all active and inactive participants2016-09-01191
Total participants2016-09-01191
2015: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01129
Total number of active participants reported on line 7a of the Form 55002015-09-01182
Number of retired or separated participants receiving benefits2015-09-010
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-01182
Total participants2015-09-01182
2014: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01112
Total number of active participants reported on line 7a of the Form 55002014-09-01129
Total of all active and inactive participants2014-09-01129
Total participants2014-09-01129
2013: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01114
Total number of active participants reported on line 7a of the Form 55002013-09-01118
Number of retired or separated participants receiving benefits2013-09-011
Total of all active and inactive participants2013-09-01119
Total participants2013-09-01119
2012: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01100
Total number of active participants reported on line 7a of the Form 55002012-09-01114
Number of retired or separated participants receiving benefits2012-09-011
Total of all active and inactive participants2012-09-01115
Total participants2012-09-01115
2011: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01111
Total number of active participants reported on line 7a of the Form 55002011-09-01100
Total of all active and inactive participants2011-09-01100
Total participants2011-09-01100

Form 5500 Responses for HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN

2022: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01Plan funding arrangement – InsuranceYes
2022-09-01Plan benefit arrangement – InsuranceYes
2021: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Submission has been amendedNo
2019-09-01This submission is the final filingNo
2019-09-01This return/report is a short plan year return/report (less than 12 months)No
2019-09-01Plan is a collectively bargained planNo
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2016: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Submission has been amendedYes
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Submission has been amendedYes
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: HARNESS ROOFING, INC. EMPLOYEE WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01First time form 5500 has been submittedYes
2011-09-01Submission has been amendedYes
2011-09-01This submission is the final filingNo
2011-09-01This return/report is a short plan year return/report (less than 12 months)No
2011-09-01Plan is a collectively bargained planNo
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number029589
Policy instance 1
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000003568
Policy instance 2
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 5
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 4
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number029793
Policy instance 6
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00633614
Policy instance 1
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 4
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000003568
Policy instance 2
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000003568
Policy instance 1
Insurance contract or identification number000003568
Number of Individuals Covered409
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $12,634
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number029793
Policy instance 2
Insurance contract or identification number029793
Number of Individuals Covered235
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $1,822
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number53761
Policy instance 3
Insurance contract or identification number53761
Number of Individuals Covered226
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $52,163
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,333,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 4
Insurance contract or identification number155397
Number of Individuals Covered46
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $1,938
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 5
Insurance contract or identification number155397
Number of Individuals Covered129
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $4,107
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number53761
Policy instance 6
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5994892
Policy instance 5
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 4
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000003568
Policy instance 3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29793
Policy instance 2
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155397
Policy instance 1

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