401k Plan data: BALLYMORE COMPANY, INC BENEFIT PLAN plan

BALLYMORE COMPANY, INC BENEFIT PLAN 401k Plan overview

Plan Name	BALLYMORE COMPANY, INC BENEFIT PLAN
Plan identification number	501

BALLYMORE COMPANY, INC 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

401k Sponsoring company profile

BALLYMORE COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: BALLYMORE COMPANY, INC.

Employer identification number (EIN): 832861022

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BALLYMORE COMPANY, INC BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MICHAEL CAFFREY 2024-10-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	MICHAEL CAFFREY	2024-10-09

Form 5500 Responses for BALLYMORE COMPANY, INC BENEFIT PLAN

2023: BALLYMORE COMPANY, INC BENEFIT 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

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

10569544

Policy instance

Insurance contract or identification number	10569544
Number of Individuals Covered	219
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $48,308
Total amount of fees paid to insurance company	USD $2,786
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

21637

Policy instance

Insurance contract or identification number	21637
Number of Individuals Covered	233
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $35,764
Total amount of fees paid to insurance company	USD $7,392
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $280,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

BALLYMORE COMPANY, INC. 401(K) PROFIT SHARING PLAN [EIN = 232953689]

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Company Name:	BALLYMORE COMPANY, INC.
Employer identification number (EIN):	832861022
NAIC Classification:	332900