401k Plan data: OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE plan

OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE 401k Plan overview

Plan Name	OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE
Plan identification number	502

OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

OUTER BANKS CAPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: OUTER BANKS CAPITAL, INC.

Employer identification number (EIN): 852850437

NAIC Classification: 531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-01-01 NATHAN BROWN 2023-10-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-01-01	NATHAN BROWN	2023-10-26

Plan Statistics for OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE

401k plan membership statisitcs for OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE

Measure Date Value
2021: OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE 2021 401k membership
Total participants, beginning-of-year 2021-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 0

Measure	Date	Value
2021: OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE 2021 401k membership
Total participants, beginning-of-year	2021-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	0

Form 5500 Responses for OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE

2021: OUTER BANKS CAPITAL, INC. 502 ACCIDENT, LIFE, SHORT TERM, AND LONG TERM INSURANCE 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

912543

Policy instance

Insurance contract or identification number	912543
Number of Individuals Covered	130
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,543
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $45,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,543
Insurance broker organization code?	5

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Company Name:	OUTER BANKS CAPITAL, INC.
Employer identification number (EIN):	852850437
NAIC Classification:	531310