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CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 401k Plan overview

Plan NameCHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN
Plan identification number 501

CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH 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

CHAMBERLIN ROOFING AND WATERPROOFING has sponsored the creation of one or more 401k plans.

Company Name:CHAMBERLIN ROOFING AND WATERPROOFING
Employer identification number (EIN):271500189
NAIC Classification:236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-05-01SHAWN BUZEK2024-10-22
5012022-05-01SHAWN BUZEK2023-10-05
5012021-05-01SHAWN BUZEK2022-09-21
5012020-05-01SHAWN BUZEK2021-09-08
5012019-05-01SHAWN BUZEK2020-09-04
5012018-05-01SHAWN BUZEK2019-10-22
5012017-05-01
5012016-05-01
5012015-05-01SHAWN BUZEK
5012014-05-01RICHARD DYKE
5012013-05-01SIDNEY SCANLAN
5012012-05-01SIDNEY SCANLAN
5012011-05-01SIDNEY SCANLAN

Plan Statistics for CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN

401k plan membership statisitcs for CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN

Measure Date Value
2023: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year2023-05-01231
Total number of active participants reported on line 7a of the Form 55002023-05-01167
Number of retired or separated participants receiving benefits2023-05-010
Number of other retired or separated participants entitled to future benefits2023-05-010
Total of all active and inactive participants2023-05-01167
Number of employers contributing to the scheme2023-05-010
2022: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-01233
Total number of active participants reported on line 7a of the Form 55002022-05-01231
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-01231
Number of employers contributing to the scheme2022-05-010
2021: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-01254
Total number of active participants reported on line 7a of the Form 55002021-05-01233
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-01233
Number of employers contributing to the scheme2021-05-010
2020: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-01302
Total number of active participants reported on line 7a of the Form 55002020-05-01254
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-01254
Number of employers contributing to the scheme2020-05-010
2019: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-01246
Total number of active participants reported on line 7a of the Form 55002019-05-01302
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-01302
Number of employers contributing to the scheme2019-05-010
2018: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01230
Total number of active participants reported on line 7a of the Form 55002018-05-01246
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-01246
Number of employers contributing to the scheme2018-05-010
2017: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01467
Total number of active participants reported on line 7a of the Form 55002017-05-01230
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-01230
2016: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01193
Total number of active participants reported on line 7a of the Form 55002016-05-01210
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-01210
2015: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-01118
Total number of active participants reported on line 7a of the Form 55002015-05-01193
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01193
2014: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01112
Total number of active participants reported on line 7a of the Form 55002014-05-01118
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01118
2013: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01114
Total number of active participants reported on line 7a of the Form 55002013-05-01112
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-01112
2012: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01114
Total number of active participants reported on line 7a of the Form 55002012-05-01145
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-01145
2011: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01109
Total number of active participants reported on line 7a of the Form 55002011-05-01114
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-01114

Form 5500 Responses for CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN

2023: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2023 form 5500 responses
2023-05-01Type of plan entitySingle employer plan
2023-05-01Plan funding arrangement – InsuranceYes
2023-05-01Plan benefit arrangement – InsuranceYes
2022: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – InsuranceYes
2021: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – InsuranceYes
2020: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes
2019: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2018: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: CHAMBERLIN ROOFING AND WATERPROOFING GROUP HEALTH PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberAI110634
Policy instance 5
Insurance contract or identification numberAI110634
Number of Individuals Covered167
Insurance policy start date2023-05-01
Insurance policy end date2024-04-30
Total amount of commissions paid to insurance brokerUSD $58,660
Total amount of fees paid to insurance companyUSD $2,707
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $90,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX970358
Policy instance 4
Insurance contract or identification numberFLX970358
Number of Individuals Covered167
Insurance policy start date2023-05-01
Insurance policy end date2024-04-30
Total amount of commissions paid to insurance brokerUSD $11,358
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $75,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3345632
Policy instance 3
Insurance contract or identification number3345632
Number of Individuals Covered167
Insurance policy start date2023-05-01
Insurance policy end date2024-04-30
Total amount of commissions paid to insurance brokerUSD $10,898
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $110,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number452300000
Policy instance 2
Insurance contract or identification number452300000
Number of Individuals Covered92
Insurance policy start date2023-05-01
Insurance policy end date2024-04-30
Total amount of commissions paid to insurance brokerUSD $21,295
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number917275
Policy instance 1
Insurance contract or identification number917275
Number of Individuals Covered300
Insurance policy start date2023-05-01
Insurance policy end date2024-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $41,405
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,071,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number452300000
Policy instance 3
Insurance contract or identification number452300000
Number of Individuals Covered149
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $36,409
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $94,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
Insurance contract or identification number427780
Number of Individuals Covered231
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $56,131
Total amount of fees paid to insurance companyUSD $1,508
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $261,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number917275
Policy instance 1
Insurance contract or identification number917275
Number of Individuals Covered293
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $-11
Total amount of fees paid to insurance companyUSD $43,886
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,151,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number917275
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number452300000
Policy instance 3
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number452300000
Policy instance 3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number917275
Policy instance 1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number917275
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )
Policy contract number452300000
Policy instance 3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number5G9612
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number513089
Policy instance 1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number259308/513089
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number259308/513089
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number259308/513089
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number259308/513089
Policy instance 1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number513089
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number427780
Policy instance 2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number6759
Policy instance 3

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