401k Plan data: BLUE ROCK CONSTRUCTION, INC. 401K PLAN plan

BLUE ROCK CONSTRUCTION, INC. 401K PLAN 401k Plan overview

Plan Name	BLUE ROCK CONSTRUCTION, INC. 401K PLAN
Plan identification number	001

BLUE ROCK CONSTRUCTION, INC. 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

BLUE ROCK CONSTRUCTION, INC. has sponsored the creation of one or more 401k plans.

Company Name: BLUE ROCK CONSTRUCTION, INC.

Employer identification number (EIN): 010548802

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE ROCK CONSTRUCTION, INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 STEPHEN KETTELBERGER 2024-10-15
001 2022-01-01 STEPHEN KETTELBERGER 2023-10-15
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01 STEPHEN KETTELBERGER 2017-10-11
001 2015-01-01 STEPHEN KETTELBERGER 2016-09-29
001 2014-01-01 STEPHEN KETTELBERGER 2015-10-06
001 2013-01-01 STEPHEN KETTELBERGER 2014-07-21
001 2012-01-01 STEPHEN KETTELBERGER 2013-09-17
001 2011-01-01 STEPHEN KETTELBERGER 2012-10-10
001 2010-01-01 STEPHEN KETTELBERGER
001 2009-01-01 STEPHEN KETTELBERGER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2023-01-01	STEPHEN KETTELBERGER	2024-10-15
001	2022-01-01	STEPHEN KETTELBERGER	2023-10-15
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01	STEPHEN KETTELBERGER	2017-10-11
001	2015-01-01	STEPHEN KETTELBERGER	2016-09-29
001	2014-01-01	STEPHEN KETTELBERGER	2015-10-06
001	2013-01-01	STEPHEN KETTELBERGER	2014-07-21
001	2012-01-01	STEPHEN KETTELBERGER	2013-09-17
001	2011-01-01	STEPHEN KETTELBERGER	2012-10-10
001	2010-01-01	STEPHEN KETTELBERGER
001	2009-01-01	STEPHEN KETTELBERGER

Plan Statistics for BLUE ROCK CONSTRUCTION, INC. 401K PLAN

401k plan membership statisitcs for BLUE ROCK CONSTRUCTION, INC. 401K PLAN

Measure Date Value
2023: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 81
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 37
Total of all active and inactive participants 2023-01-01 118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 118
Number of participants with account balances 2023-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 2
2022: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 91
Number of retired or separated participants receiving benefits 2022-01-01 2
Number of other retired or separated participants entitled to future benefits 2022-01-01 24
Total of all active and inactive participants 2022-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 117
Number of participants with account balances 2022-01-01 104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 4
2010: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 22
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 4
Total of all active and inactive participants 2010-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 26
Number of participants with account balances 2010-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 18
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 6
Total of all active and inactive participants 2009-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 24
Number of participants with account balances 2009-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2023: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	81
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	37
Total of all active and inactive participants	2023-01-01	118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	118
Number of participants with account balances	2023-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	2
2022: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	91
Number of retired or separated participants receiving benefits	2022-01-01	2
Number of other retired or separated participants entitled to future benefits	2022-01-01	24
Total of all active and inactive participants	2022-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	117
Number of participants with account balances	2022-01-01	104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	4
2010: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	22
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	4
Total of all active and inactive participants	2010-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	26
Number of participants with account balances	2010-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	18
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	6
Total of all active and inactive participants	2009-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	24
Number of participants with account balances	2009-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on BLUE ROCK CONSTRUCTION, INC. 401K PLAN

Measure	Date	Value
2023 : BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$2,915,001
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$1,040,265
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$1,000,995
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$1,370,923
Value of total assets at end of year	2023-12-31	$10,555,267
Value of total assets at beginning of year	2023-12-31	$8,680,531
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$39,270
Total interest from all sources	2023-12-31	$2,563
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$800,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$774,669
Participant contributions at end of year	2023-12-31	$68,497
Participant contributions at beginning of year	2023-12-31	$43,552
Participant contributions at end of year	2023-12-31	$11,830
Participant contributions at beginning of year	2023-12-31	$21,500
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$224,581
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$1,874,736
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$10,555,267
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$8,680,531
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$7,444,512
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$6,960,218
Interest on participant loans	2023-12-31	$2,563
Value of interest in common/collective trusts at end of year	2023-12-31	$1,911,295
Value of interest in common/collective trusts at beginning of year	2023-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2023-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2023-12-31	$1,000,749
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2023-12-31	$1,000,749
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$1,093,254
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$644,798
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$1,391,762
Net investment gain or loss from common/collective trusts	2023-12-31	$149,753
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$371,673
Employer contributions (assets) at end of year	2023-12-31	$25,879
Employer contributions (assets) at beginning of year	2023-12-31	$9,714
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$1,000,995
Contract administrator fees	2023-12-31	$39,270
Did the plan have assets held for investment	2023-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2023-12-31	410746749
2022 : BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-334,194
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$442,854
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$392,788
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,298,650
Value of total assets at end of year	2022-12-31	$8,680,531
Value of total assets at beginning of year	2022-12-31	$9,457,579
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$50,066
Total interest from all sources	2022-12-31	$3,125
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$119,680
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$119,680
Administrative expenses professional fees incurred	2022-12-31	$50,066
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$767,162
Participant contributions at end of year	2022-12-31	$43,552
Participant contributions at beginning of year	2022-12-31	$93,843
Participant contributions at end of year	2022-12-31	$21,500
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$185,693
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-777,048
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$8,680,531
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$9,457,579
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$6,960,218
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$9,363,736
Interest on participant loans	2022-12-31	$3,125
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$1,000,749
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$644,798
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,755,649
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$345,795
Employer contributions (assets) at end of year	2022-12-31	$9,714
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$392,788
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2022-12-31	410746749
2010 : BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$326,927
Expenses. Total of all expenses incurred	2010-12-31	$84,487
Benefits paid (including direct rollovers)	2010-12-31	$84,017
Total plan assets at end of year	2010-12-31	$1,077,361
Total plan assets at beginning of year	2010-12-31	$834,921
Value of fidelity bond covering the plan	2010-12-31	$25,000
Total contributions received or receivable from participants	2010-12-31	$147,284
Noncash contributions received	2010-12-31	$100,069
Net income (gross income less expenses)	2010-12-31	$242,440
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,077,361
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$834,921
Assets. Value of participant loans	2010-12-31	$42,881
Total contributions received or receivable from employer(s)	2010-12-31	$79,574
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$470
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for BLUE ROCK CONSTRUCTION, INC. 401K PLAN

2023: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2010: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: BLUE ROCK CONSTRUCTION, INC. 401K PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

512463-000

Policy instance

Insurance contract or identification number	512463-000
Number of Individuals Covered	0
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,741
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?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

512463

Policy instance

Insurance contract or identification number	512463
Number of Individuals Covered	104
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,198
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?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4198
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker organization code?	5

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Company Name:	BLUE ROCK CONSTRUCTION, INC.
Employer identification number (EIN):	010548802
NAIC Classification:	236200