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US FLOORS INC. BENEFIT PLAN 401k Plan overview

Plan NameUS FLOORS INC. BENEFIT PLAN
Plan identification number 501

US FLOORS INC. BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

US FLOORS, INC. has sponsored the creation of one or more 401k plans.

Company Name:US FLOORS, INC.
Employer identification number (EIN):201974373
NAIC Classification:314000
NAIC Description: Textile Product Mills

Additional information about US FLOORS, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2014-01-13
Company Identification Number: P14000004039
Legal Registered Office Address: 19100 SW 106 AVE UNIT 6

CUTLER BAY

33157

More information about US FLOORS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan US FLOORS INC. BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-06-01RUSSELL GUINN RUSSELL GUINN2017-12-28
5012015-06-01RUSSELL GUINN RUSSELL GUINN2016-12-31
5012014-06-01RUSSELL GUINN RUSSELL GUINN2016-03-14

Plan Statistics for US FLOORS INC. BENEFIT PLAN

401k plan membership statisitcs for US FLOORS INC. BENEFIT PLAN

Measure Date Value
2016: US FLOORS INC. BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01155
Total number of active participants reported on line 7a of the Form 55002016-06-01210
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01210
2015: US FLOORS INC. BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01200
Total number of active participants reported on line 7a of the Form 55002015-06-01155
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01155
2014: US FLOORS INC. BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-010
Total number of active participants reported on line 7a of the Form 55002014-06-01200
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01200

Financial Data on US FLOORS INC. BENEFIT PLAN

Measure Date Value
2017 : US FLOORS INC. BENEFIT PLAN 2017 401k financial data
Total income from all sources2017-05-31$0
Total plan assets at end of year2017-05-31$0
Total plan assets at beginning of year2017-05-31$0
Net plan assets at end of year (total assets less liabilities)2017-05-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-05-31$0
2016 : US FLOORS INC. BENEFIT PLAN 2016 401k financial data
Total income from all sources2016-05-31$0
Total plan assets at end of year2016-05-31$0
Total plan assets at beginning of year2016-05-31$0
Net plan assets at end of year (total assets less liabilities)2016-05-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-05-31$0
2015 : US FLOORS INC. BENEFIT PLAN 2015 401k financial data
Total income from all sources2015-05-31$0
Total plan assets at end of year2015-05-31$0
Total plan assets at beginning of year2015-05-31$0
Net plan assets at end of year (total assets less liabilities)2015-05-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-05-31$0

Form 5500 Responses for US FLOORS INC. BENEFIT PLAN

2016: US FLOORS INC. BENEFIT PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01This submission is the final filingYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: US FLOORS INC. BENEFIT PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: US FLOORS INC. BENEFIT PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01First time form 5500 has been submittedYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGA8653
Policy instance 1
Insurance contract or identification numberGA8653
Number of Individuals Covered117
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $47,072
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,069,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,072
Additional information about fees paid to insurance brokerACCOUNT SERVICE (EE&ER)
Insurance broker organization code?3
Insurance broker nameADCOCK FINANCIAL GROUP, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00512727
Policy instance 2
Insurance contract or identification number00512727
Number of Individuals Covered155
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $29,533
Total amount of fees paid to insurance companyUSD $3,244
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,214
Amount paid for insurance broker fees3244
Insurance broker organization code?3
Insurance broker nameASHFORD ADVISORS, INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number151767
Policy instance 3
Insurance contract or identification number151767
Number of Individuals Covered131
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $2,179
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,179
Insurance broker organization code?3
Insurance broker nameADCOCK FINANCIAL GROUP
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-040768
Policy instance 2
Insurance contract or identification number010-040768
Number of Individuals Covered167
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ALLIANT HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 11256 )
Policy contract numberA13530001
Policy instance 1
Insurance contract or identification numberA13530001
Number of Individuals Covered192
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $24,686
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $705,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,686
Additional information about fees paid to insurance brokerACCOUNT SERVICE (EE&ER)
Insurance broker organization code?3
Insurance broker nameADCOCK FINANCIAL GROUP, INC.
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5452774
Policy instance 3
Insurance contract or identification number5452774
Number of Individuals Covered43
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $8,910
Total amount of fees paid to insurance companyUSD $34
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $59,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,910
Amount paid for insurance broker fees34
Additional information about fees paid to insurance brokerNON MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameADCOCK FINANCIAL GROUP
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number151767
Policy instance 4
Insurance contract or identification number151767
Number of Individuals Covered67
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $903
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $903
Insurance broker organization code?3
Insurance broker nameADCOCK FINANCIAL GROUP
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05318708
Policy instance 5
Insurance contract or identification numberTS05318708
Number of Individuals Covered96
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $4,820
Total amount of fees paid to insurance companyUSD $945
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $10,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,410
Amount paid for insurance broker fees136
Additional information about fees paid to insurance brokerADMIN FEES
Insurance broker organization code?5
Insurance broker nameADCOCK FINANCIAL GROUP

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