401k Plan data: AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN plan

AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN
Plan identification number	501

AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT 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) Other welfare benefit cover

401k Sponsoring company profile

AAA KARTAK, CO has sponsored the creation of one or more 401k plans.

Company Name: AAA KARTAK, CO

Employer identification number (EIN): 820655404

NAIC Classification: 238300

Additional information about AAA KARTAK, CO

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2017-02-28

Company Identification Number: 604093267

Legal Registered Office Address: 13214 4TH AVE W

EVERETT
United States of America (USA)
982046336

More information about AAA KARTAK, CO

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-12-01 CAMERON KARTAK 2023-09-15
501 2020-12-01 CAMERON KARTAK 2022-06-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-12-01	CAMERON KARTAK	2023-09-15
501	2020-12-01	CAMERON KARTAK	2022-06-21

Plan Statistics for AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN

401k plan membership statisitcs for AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN

Measure Date Value
2021: AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 104
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 104
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 104
Number of employers contributing to the scheme 2021-12-01 0
2020: AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-12-01 104
Total number of active participants reported on line 7a of the Form 5500 2020-12-01 104
Number of retired or separated participants receiving benefits 2020-12-01 0
Number of other retired or separated participants entitled to future benefits 2020-12-01 0
Total of all active and inactive participants 2020-12-01 104
Number of employers contributing to the scheme 2020-12-01 0

Measure	Date	Value
2021: AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	104
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	104
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	104
Number of employers contributing to the scheme	2021-12-01	0
2020: AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-12-01	104
Total number of active participants reported on line 7a of the Form 5500	2020-12-01	104
Number of retired or separated participants receiving benefits	2020-12-01	0
Number of other retired or separated participants entitled to future benefits	2020-12-01	0
Total of all active and inactive participants	2020-12-01	104
Number of employers contributing to the scheme	2020-12-01	0

Form 5500 Responses for AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN

2021: AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2020: AAA KARTAK GLASS & CLOSET CORP. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-12-01	Type of plan entity	Single employer plan
2020-12-01	First time form 5500 has been submitted	Yes
2020-12-01	Plan funding arrangement – Insurance	Yes
2020-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2488

Policy instance

Insurance contract or identification number	2488
Number of Individuals Covered	104
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

8U4563

Policy instance

Insurance contract or identification number	8U4563
Number of Individuals Covered	164
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $29,958
Total amount of fees paid to insurance company	USD $2,170
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $577,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,333
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )

Policy contract number

2488

Policy instance

Insurance contract or identification number	2488
Number of Individuals Covered	102
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

8U4563

Policy instance

Insurance contract or identification number	8U4563
Number of Individuals Covered	156
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $28,574
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $572,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,574
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	AAA KARTAK, CO
Employer identification number (EIN):	820655404
NAIC Classification:	238300

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2017-02-28
Company Identification Number:	604093267
Legal Registered Office Address:	13214 4TH AVE W EVERETT United States of America (USA) 982046336