401k Plan data: ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN plan

ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN 401k Plan overview

Plan Name	ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN
Plan identification number	501

ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Vision Temporary disability (accident and sickness)

401k Sponsoring company profile

ROLL FORM GROUP U.S., INC has sponsored the creation of one or more 401k plans.

Company Name: ROLL FORM GROUP U.S., INC

Employer identification number (EIN): 980473981

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-04-01 JAMES MEADOWS
501 2016-04-01 JAMES MEADOWS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-04-01	JAMES MEADOWS
501	2016-04-01	JAMES MEADOWS

Plan Statistics for ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN

401k plan membership statisitcs for ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN

Measure Date Value
2017: ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 279
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 243
Total of all active and inactive participants 2017-04-01 243
2016: ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 147
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 279
Total of all active and inactive participants 2016-04-01 279

Measure	Date	Value
2017: ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	279
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	243
Total of all active and inactive participants	2017-04-01	243
2016: ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	147
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	279
Total of all active and inactive participants	2016-04-01	279

Form 5500 Responses for ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN

2017: ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: ROLL FORM GROUP (U.S.), INC. GROUP HEALTHCARE PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	First time form 5500 has been submitted	Yes
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

73520

Policy instance

Insurance contract or identification number	73520
Number of Individuals Covered	243
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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

00428104

Policy instance

Insurance contract or identification number	00428104
Number of Individuals Covered	114
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $5,521
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, OPTIONAL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $48,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,521
Insurance broker organization code?	3
Insurance broker name	LIPSCOMB & PITTS INSURNACE

HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )

Policy contract number

405970 0040

Policy instance

Insurance contract or identification number	405970 0040
Number of Individuals Covered	120
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $158,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	PREMIER CONSULTING ASSOCIATES

Potentially related plans

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	ROLL FORM GROUP U.S., INC
Employer identification number (EIN):	980473981
NAIC Classification:	332900