401k Plan data: NATE HOLYOKE BUILDERS, INC. LIFE INSURANCE AND DISABILITY PLAN plan

NATE HOLYOKE BUILDERS, INC. LIFE INSURANCE AND DISABILITY PLAN 401k Plan overview

Plan Name	NATE HOLYOKE BUILDERS, INC. LIFE INSURANCE AND DISABILITY PLAN
Plan identification number	501

NATE HOLYOKE BUILDERS, INC. LIFE INSURANCE AND DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

NATE HOLYOKE BUILDERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: NATE HOLYOKE BUILDERS, INC.

Employer identification number (EIN): 260536393

NAIC Classification: 236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NATE HOLYOKE BUILDERS, INC. LIFE INSURANCE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-03-01 BRANDI GILLIE 2024-09-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-03-01	BRANDI GILLIE	2024-09-27

Form 5500 Responses for NATE HOLYOKE BUILDERS, INC. LIFE INSURANCE AND DISABILITY PLAN

2023: NATE HOLYOKE BUILDERS, INC. LIFE INSURANCE AND DISABILITY PLAN 2023 form 5500 responses
2023-03-01	Type of plan entity	Single employer plan
2023-03-01	First time form 5500 has been submitted	Yes
2023-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-03-01	Plan funding arrangement – Insurance	Yes
2023-03-01	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

GLUG0BPQW

Policy instance

Insurance contract or identification number	GLUG0BPQW
Number of Individuals Covered	106
Insurance policy start date	2023-03-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $542
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,419
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

GUC 0BPQW

Policy instance

Insurance contract or identification number	GUC 0BPQW
Number of Individuals Covered	47
Insurance policy start date	2023-03-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,882
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,821
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

GUPR0BPQW

Policy instance

Insurance contract or identification number	GUPR0BPQW
Number of Individuals Covered	30
Insurance policy start date	2023-03-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,873
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,583
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

GVTL0BPQW

Policy instance

Insurance contract or identification number	GVTL0BPQW
Number of Individuals Covered	32
Insurance policy start date	2023-03-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,474
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $9,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NATE HOLYOKE BUILDERS, INC.
Employer identification number (EIN):	260536393
NAIC Classification:	236110