401k Plan data: CENTURY CONCRETE HEALTH PLAN plan

CENTURY CONCRETE HEALTH PLAN 401k Plan overview

Plan Name	CENTURY CONCRETE HEALTH PLAN
Plan identification number	502

CENTURY CONCRETE HEALTH PLAN Benefits

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

401k Sponsoring company profile

CENTURY CONCRETE LLC has sponsored the creation of one or more 401k plans.

Company Name: CENTURY CONCRETE LLC

Employer identification number (EIN): 873682095

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTURY CONCRETE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-03-01 KENNETH BOWAB 2023-08-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2022-03-01	KENNETH BOWAB	2023-08-09

Plan Statistics for CENTURY CONCRETE HEALTH PLAN

401k plan membership statisitcs for CENTURY CONCRETE HEALTH PLAN

Measure Date Value
2022: CENTURY CONCRETE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 341
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 341
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 341
Number of employers contributing to the scheme 2022-03-01 0

Measure	Date	Value
2022: CENTURY CONCRETE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	341
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	341
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	341
Number of employers contributing to the scheme	2022-03-01	0

Form 5500 Responses for CENTURY CONCRETE HEALTH PLAN

2022: CENTURY CONCRETE HEALTH PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

549918

Policy instance

Insurance contract or identification number	549918
Number of Individuals Covered	341
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $5,288
Total amount of fees paid to insurance company	USD $2,632
Life 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 $52,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,288
Amount paid for insurance broker fees	2632
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )

Policy contract number

B5KJY

Policy instance

Insurance contract or identification number	B5KJY
Number of Individuals Covered	218
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $2,919
Total amount of fees paid to insurance company	USD $5,851
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,919
Amount paid for insurance broker fees	5851
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

600086

Policy instance

Insurance contract or identification number	600086
Number of Individuals Covered	297
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $5,453
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,453
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 )

Policy contract number

B5KJY

Policy instance

Insurance contract or identification number	B5KJY
Number of Individuals Covered	138
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $2,919
Total amount of fees paid to insurance company	USD $5,851
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,919
Amount paid for insurance broker fees	5851
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	CENTURY CONCRETE LLC
Employer identification number (EIN):	873682095
NAIC Classification:	238900