401k Plan data: GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN plan

GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN
Plan identification number	501

GEORGE MOEHRLE MASONRY, INC. WELFARE 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 Other welfare benefit cover

401k Sponsoring company profile

GEORGE MOEHRLE MASONRY, INC. has sponsored the creation of one or more 401k plans.

Company Name: GEORGE MOEHRLE MASONRY, INC.

Employer identification number (EIN): 521438573

NAIC Classification: 238100

Additional information about GEORGE MOEHRLE MASONRY, INC.

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 2013-08-07

Company Identification Number: F193689

Legal Registered Office Address: 11350 RANDOM HILLS RD STE 500

FAIRFAX
United States of America (USA)
22030

More information about GEORGE MOEHRLE MASONRY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-10-01 LISA FERRIS 2020-04-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-10-01	LISA FERRIS	2020-04-08

Plan Statistics for GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN

Measure Date Value
2018: GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 105
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 0
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 0

Measure	Date	Value
2018: GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	105
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	0
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	0

Form 5500 Responses for GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN

2018: GEORGE MOEHRLE MASONRY, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	First time form 5500 has been submitted	Yes
2018-10-01	Submission has been amended	No
2018-10-01	This submission is the final filing	Yes
2018-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-10-01	Plan is a collectively bargained plan	No
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

7X3218

Policy instance

Insurance contract or identification number	7X3218
Number of Individuals Covered	25
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $6,834
Total amount of fees paid to insurance company	USD $584
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	Yes
Dental Insurance Welfare Benefit	No
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 $181,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,230
Amount paid for insurance broker fees	304
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

5359639

Policy instance

Insurance contract or identification number	5359639
Number of Individuals Covered	66
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $3,377
Total amount of fees paid to insurance company	USD $1,181
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $16,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,377
Amount paid for insurance broker fees	844
Additional information about fees paid to insurance broker	ADMIN FEES
Insurance broker organization code?	5

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

Policy contract number

00554258

Policy instance

Insurance contract or identification number	00554258
Number of Individuals Covered	76
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $3,337
Total amount of fees paid to insurance company	USD $0
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	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	AD&D
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 $25,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,567
Insurance broker organization code?	3

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Company Name:	GEORGE MOEHRLE MASONRY, INC.
Employer identification number (EIN):	521438573
NAIC Classification:	238100

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	2013-08-07
Company Identification Number:	F193689
Legal Registered Office Address:	11350 RANDOM HILLS RD STE 500 FAIRFAX United States of America (USA) 22030