401k Plan data: plan

Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CORNERSTONE BUILDERS OF SW FLORI has sponsored the creation of one or more 401k plans.

Company Name: CORNERSTONE BUILDERS OF SW FLORI

Employer identification number (EIN): 223915170

NAIC Classification: 321210

Form 5500 Filing Information

Submission information for form 5500 for 401k plan

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-07-01 KATHRYN PANTELUP 2024-11-12
502 2022-07-01 KATHRYN PANTELUP 2023-10-03
502 2021-07-01 TODD GARNIER 2022-10-05
502 2020-07-01 KATHLEEN NICHOLS 2021-10-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2023-07-01	KATHRYN PANTELUP	2024-11-12
502	2022-07-01	KATHRYN PANTELUP	2023-10-03
502	2021-07-01	TODD GARNIER	2022-10-05
502	2020-07-01	KATHLEEN NICHOLS	2021-10-20

Plan Statistics for

401k plan membership statisitcs for

Measure Date Value
2023: 2023 401k membership
Total participants, beginning-of-year 2023-07-01 266
Total number of active participants reported on line 7a of the Form 5500 2023-07-01 214
Number of retired or separated participants receiving benefits 2023-07-01 0
Number of other retired or separated participants entitled to future benefits 2023-07-01 0
Total of all active and inactive participants 2023-07-01 214
Number of employers contributing to the scheme 2023-07-01 0
2022: 2022 401k membership
Total participants, beginning-of-year 2022-07-01 252
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 254
Number of retired or separated participants receiving benefits 2022-07-01 2
Number of other retired or separated participants entitled to future benefits 2022-07-01 4
Total of all active and inactive participants 2022-07-01 260
Number of employers contributing to the scheme 2022-07-01 0
2021: 2021 401k membership
Total participants, beginning-of-year 2021-07-01 231
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 251
Number of retired or separated participants receiving benefits 2021-07-01 1
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 252
Number of employers contributing to the scheme 2021-07-01 0
2020: 2020 401k membership
Total participants, beginning-of-year 2020-07-01 242
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 237
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 237
Number of employers contributing to the scheme 2020-07-01 0

Measure	Date	Value
2023: 2023 401k membership
Total participants, beginning-of-year	2023-07-01	266
Total number of active participants reported on line 7a of the Form 5500	2023-07-01	214
Number of retired or separated participants receiving benefits	2023-07-01	0
Number of other retired or separated participants entitled to future benefits	2023-07-01	0
Total of all active and inactive participants	2023-07-01	214
Number of employers contributing to the scheme	2023-07-01	0
2022: 2022 401k membership
Total participants, beginning-of-year	2022-07-01	252
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	254
Number of retired or separated participants receiving benefits	2022-07-01	2
Number of other retired or separated participants entitled to future benefits	2022-07-01	4
Total of all active and inactive participants	2022-07-01	260
Number of employers contributing to the scheme	2022-07-01	0
2021: 2021 401k membership
Total participants, beginning-of-year	2021-07-01	231
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	251
Number of retired or separated participants receiving benefits	2021-07-01	1
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	252
Number of employers contributing to the scheme	2021-07-01	0
2020: 2020 401k membership
Total participants, beginning-of-year	2020-07-01	242
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	237
Number of retired or separated participants receiving benefits	2020-07-01	0
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	237
Number of employers contributing to the scheme	2020-07-01	0

Form 5500 Responses for

2023: 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2022: 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BXF9

Policy instance

Insurance contract or identification number	GLUG0BXF9
Number of Individuals Covered	219
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $5,831
Total amount of fees paid to insurance company	USD $7,202
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $58,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

HEC698

Policy instance

Insurance contract or identification number	HEC698
Number of Individuals Covered	72
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
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $4,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-056825

Policy instance

Insurance contract or identification number	010-056825
Number of Individuals Covered	193
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $5,905
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

98609

Policy instance

Insurance contract or identification number	98609
Number of Individuals Covered	5
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $3,066
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

98609

Policy instance

Insurance contract or identification number	98609
Number of Individuals Covered	74
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $52,598
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

98609

Policy instance

Insurance contract or identification number	98609
Number of Individuals Covered	94
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $60,657
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

98609

Policy instance

Insurance contract or identification number	98609
Number of Individuals Covered	3
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,615
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-56825

Policy instance

Insurance contract or identification number	010-56825
Number of Individuals Covered	266
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $5,708
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

HEC698

Policy instance

Insurance contract or identification number	HEC698
Number of Individuals Covered	66
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $612
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $3,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BXF9

Policy instance

Insurance contract or identification number	GLUG0BXF9
Number of Individuals Covered	260
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $5,523
Total amount of fees paid to insurance company	USD $5,919
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $55,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BXF9

Policy instance

TELADOC PHYSICIANS, P.A. (National Association of Insurance Commissioners NAIC id number: 12454 )

Policy contract number

HEC698

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50035192

Policy instance

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-56825

Policy instance

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

98609

Policy instance

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

98609

Policy instance

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

98609

Policy instance

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

E5851-YN4908

Policy instance

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

37537

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50035192

Policy instance

TELADOC PHYSICIANS, P.A. (National Association of Insurance Commissioners NAIC id number: 12454 )

Policy contract number

HEC698

Policy instance

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

98609

Policy instance

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Company Name:	CORNERSTONE BUILDERS OF SW FLORI
Employer identification number (EIN):	223915170
NAIC Classification:	321210