401k Plan data: POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN plan

POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN 401k Plan overview

Plan Name	POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN
Plan identification number	501

POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

POWERWORKS ELECTRIC, LLC has sponsored the creation of one or more 401k plans.

Company Name: POWERWORKS ELECTRIC, LLC

Employer identification number (EIN): 208800464

NAIC Classification: 238210
NAIC Description: Electrical Contractors and Other Wiring Installation Contractors

Additional information about POWERWORKS ELECTRIC, LLC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 1246301

More information about POWERWORKS ELECTRIC, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-07-01
501 2019-07-01

Plan Statistics for POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN

401k plan membership statisitcs for POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN

Measure Date Value
2020: POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 153
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 95
Number of retired or separated participants receiving benefits 2020-07-01 1
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 96
2019: POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 127
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 155
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 155

Measure	Date	Value
2020: POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	153
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	95
Number of retired or separated participants receiving benefits	2020-07-01	1
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	96
2019: POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	127
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	155
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	155

Form 5500 Responses for POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN

2020: POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: POWERWORKS ELECTRIC, LLC MEDICAL BENEFITS PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	First time form 5500 has been submitted	Yes
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	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

0921654

Policy instance

Insurance contract or identification number	0921654
Number of Individuals Covered	215
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $7,252
Total amount of fees paid to insurance company	USD $39,909
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 $761,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $7,252
Amount paid for insurance broker fees	39909
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

082894

Policy instance

Insurance contract or identification number	082894
Number of Individuals Covered	225
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $41,978
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $41,978
Insurance broker organization code?	3

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Company Name:	POWERWORKS ELECTRIC, LLC
Employer identification number (EIN):	208800464
NAIC Classification:	238210
NAIC Description:	Electrical Contractors and Other Wiring Installation Contractors

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	1246301