401k Plan data: CROSS CITY LUMBER LLC LIFE PLAN plan

CROSS CITY LUMBER LLC LIFE PLAN 401k Plan overview

Plan Name	CROSS CITY LUMBER LLC LIFE PLAN
Plan identification number	501

CROSS CITY LUMBER LLC LIFE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CROSS CITY LUMBER, LLC has sponsored the creation of one or more 401k plans.

Company Name: CROSS CITY LUMBER, LLC

Employer identification number (EIN): 821483941

NAIC Classification: 321110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CROSS CITY LUMBER LLC LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-02-01
501 2021-02-01
501 2021-02-01
501 2020-02-01 MICHAEL TATE 2021-11-04
501 2019-02-01 MICHAEL TATE 2021-03-12

Plan Statistics for CROSS CITY LUMBER LLC LIFE PLAN

401k plan membership statisitcs for CROSS CITY LUMBER LLC LIFE PLAN

Measure Date Value
2022: CROSS CITY LUMBER LLC LIFE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-02-01 134
Total number of active participants reported on line 7a of the Form 5500 2022-02-01 145
Number of retired or separated participants receiving benefits 2022-02-01 0
Number of other retired or separated participants entitled to future benefits 2022-02-01 0
Total of all active and inactive participants 2022-02-01 145
2021: CROSS CITY LUMBER LLC LIFE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-02-01 141
Total number of active participants reported on line 7a of the Form 5500 2021-02-01 141
Number of retired or separated participants receiving benefits 2021-02-01 0
Number of other retired or separated participants entitled to future benefits 2021-02-01 0
Total of all active and inactive participants 2021-02-01 141
2020: CROSS CITY LUMBER LLC LIFE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-02-01 246
Total number of active participants reported on line 7a of the Form 5500 2020-02-01 331
Number of retired or separated participants receiving benefits 2020-02-01 0
Number of other retired or separated participants entitled to future benefits 2020-02-01 0
Total of all active and inactive participants 2020-02-01 331
Number of employers contributing to the scheme 2020-02-01 0
2019: CROSS CITY LUMBER LLC LIFE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-02-01 145
Total number of active participants reported on line 7a of the Form 5500 2019-02-01 246
Number of retired or separated participants receiving benefits 2019-02-01 0
Number of other retired or separated participants entitled to future benefits 2019-02-01 0
Total of all active and inactive participants 2019-02-01 246
Number of employers contributing to the scheme 2019-02-01 0

Measure	Date	Value
2022: CROSS CITY LUMBER LLC LIFE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-02-01	134
Total number of active participants reported on line 7a of the Form 5500	2022-02-01	145
Number of retired or separated participants receiving benefits	2022-02-01	0
Number of other retired or separated participants entitled to future benefits	2022-02-01	0
Total of all active and inactive participants	2022-02-01	145
2021: CROSS CITY LUMBER LLC LIFE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-02-01	141
Total number of active participants reported on line 7a of the Form 5500	2021-02-01	141
Number of retired or separated participants receiving benefits	2021-02-01	0
Number of other retired or separated participants entitled to future benefits	2021-02-01	0
Total of all active and inactive participants	2021-02-01	141
2020: CROSS CITY LUMBER LLC LIFE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-02-01	246
Total number of active participants reported on line 7a of the Form 5500	2020-02-01	331
Number of retired or separated participants receiving benefits	2020-02-01	0
Number of other retired or separated participants entitled to future benefits	2020-02-01	0
Total of all active and inactive participants	2020-02-01	331
Number of employers contributing to the scheme	2020-02-01	0
2019: CROSS CITY LUMBER LLC LIFE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-02-01	145
Total number of active participants reported on line 7a of the Form 5500	2019-02-01	246
Number of retired or separated participants receiving benefits	2019-02-01	0
Number of other retired or separated participants entitled to future benefits	2019-02-01	0
Total of all active and inactive participants	2019-02-01	246
Number of employers contributing to the scheme	2019-02-01	0

Form 5500 Responses for CROSS CITY LUMBER LLC LIFE PLAN

2022: CROSS CITY LUMBER LLC LIFE PLAN 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	Submission has been amended	No
2022-02-01	This submission is the final filing	No
2022-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-02-01	Plan is a collectively bargained plan	No
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: CROSS CITY LUMBER LLC LIFE PLAN 2021 form 5500 responses
2021-02-01	Type of plan entity	Single employer plan
2021-02-01	Submission has been amended	Yes
2021-02-01	This submission is the final filing	No
2021-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-02-01	Plan is a collectively bargained plan	No
2021-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes
2020: CROSS CITY LUMBER LLC LIFE PLAN 2020 form 5500 responses
2020-02-01	Type of plan entity	Single employer plan
2020-02-01	Plan funding arrangement – Insurance	Yes
2020-02-01	Plan benefit arrangement – Insurance	Yes
2019: CROSS CITY LUMBER LLC LIFE PLAN 2019 form 5500 responses
2019-02-01	Type of plan entity	Single employer plan
2019-02-01	First time form 5500 has been submitted	Yes
2019-02-01	Plan funding arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

5369805

Policy instance

Insurance contract or identification number	5369805
Number of Individuals Covered	145
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $3,093
Total amount of fees paid to insurance company	USD $499
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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	ADD
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $16,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,320
Amount paid for insurance broker fees	42
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

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

Policy contract number

757524

Policy instance

Insurance contract or identification number	757524
Number of Individuals Covered	105
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $4,845
Total amount of fees paid to insurance company	USD $725
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
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?	No
Commission paid to Insurance Broker	USD $4,691
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	3

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

Policy contract number

5369805

Policy instance

Insurance contract or identification number	5369805
Number of Individuals Covered	141
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $10,340
Total amount of fees paid to insurance company	USD $4,098
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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	ADD
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $25,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,170
Amount paid for insurance broker fees	2049
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

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

Policy contract number

5369805

Policy instance

Insurance contract or identification number	5369805
Number of Individuals Covered	331
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $5,505
Total amount of fees paid to insurance company	USD $2,121
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $27,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,505
Amount paid for insurance broker fees	1370
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3

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

Policy contract number

5369805

Policy instance

Insurance contract or identification number	5369805
Number of Individuals Covered	246
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $5,019
Total amount of fees paid to insurance company	USD $1,957
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $25,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,019
Amount paid for insurance broker fees	1252
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5

Potentially related plans

CROSS CITY FOREST PRODUCTS 401(K) PLAN [EIN = 611728848]

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Company Name:	CROSS CITY LUMBER, LLC
Employer identification number (EIN):	821483941
NAIC Classification:	321110