401k Plan data: SKYLINE RESTORATION, INC. EMPLOYEE BENEFIT PLAN plan

SKYLINE RESTORATION, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	SKYLINE RESTORATION, INC. EMPLOYEE BENEFIT PLAN
Plan identification number	501

SKYLINE RESTORATION, INC. EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

SKYLINE RESTORATION, INC. has sponsored the creation of one or more 401k plans.

Company Name: SKYLINE RESTORATION, INC.

Employer identification number (EIN): 113050504

NAIC Classification: 238100

Additional information about SKYLINE RESTORATION, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1989-05-26

Company Identification Number: 1356445

Legal Registered Office Address: 49-28 31ST PLACE
Queens
LONG ISLAND CITY
United States of America (USA)
11101

More information about SKYLINE RESTORATION, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SKYLINE RESTORATION, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 TANIA D'ALBA 2024-10-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-07-01	TANIA D'ALBA	2024-10-07

Form 5500 Responses for SKYLINE RESTORATION, INC. EMPLOYEE BENEFIT PLAN

2023: SKYLINE RESTORATION, INC. EMPLOYEE BENEFIT PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	Submission has been amended	No
2023-07-01	This submission is the final filing	No
2023-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-07-01	Plan is a collectively bargained plan	No
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417004413008

Policy instance

Insurance contract or identification number	417004413008
Number of Individuals Covered	124
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $0
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	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 $619,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1142853

Policy instance

Insurance contract or identification number	1142853
Number of Individuals Covered	116
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $17,740
Total amount of fees paid to insurance company	USD $14,129
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	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 $137,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SKYLINE RESTORATION, INC.
Employer identification number (EIN):	113050504
NAIC Classification:	238100

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1989-05-26
Company Identification Number:	1356445
Legal Registered Office Address:	49-28 31ST PLACE Queens LONG ISLAND CITY United States of America (USA) 11101