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CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 401k Plan overview

Plan NameCUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION
Plan identification number 501

CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

CUSTOM ASSEMBLY, INC. has sponsored the creation of one or more 401k plans.

Company Name:CUSTOM ASSEMBLY, INC.
Employer identification number (EIN):341466007
NAIC Classification:493100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01
5012020-02-01
5012019-02-01
5012018-02-01
5012017-02-01SCOTT MILLER

Plan Statistics for CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION

401k plan membership statisitcs for CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION

Measure Date Value
2022: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2022 401k membership
Total participants, beginning-of-year2022-02-01373
Total number of active participants reported on line 7a of the Form 55002022-02-01446
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01446
2020: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2020 401k membership
Total participants, beginning-of-year2020-02-01171
Total number of active participants reported on line 7a of the Form 55002020-02-01176
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01176
2019: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2019 401k membership
Total participants, beginning-of-year2019-02-01149
Total number of active participants reported on line 7a of the Form 55002019-02-01171
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01171
2018: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2018 401k membership
Total participants, beginning-of-year2018-02-01120
Total number of active participants reported on line 7a of the Form 55002018-02-01149
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01149
2017: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2017 401k membership
Total participants, beginning-of-year2017-02-010
Total number of active participants reported on line 7a of the Form 55002017-02-01120
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01120

Form 5500 Responses for CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION

2022: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2020: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan funding arrangement – General assets of the sponsorYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – General assets of the sponsorYes
2019: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan funding arrangement – General assets of the sponsorYes
2019-02-01Plan benefit arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – General assets of the sponsorYes
2018: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan funding arrangement – General assets of the sponsorYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – General assets of the sponsorYes
2017: CUSTOM ASSEMBLY INC CRITICAL ILLNESS, DENTAL, OPTIONAL LIFE AND VISION 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01First time form 5500 has been submittedYes
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan funding arrangement – General assets of the sponsorYes
2017-02-01Plan benefit arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberOH2355
Policy instance 1
Insurance contract or identification numberOH2355
Number of Individuals Covered187
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 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 providedACCIDENTAL DEATH & DISMEMBERMENT, VOL. LIFE
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 CarrierUSD $92,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberOH2355
Policy instance 2
Insurance contract or identification numberOH2355
Number of Individuals Covered395
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $92,433
Total amount of fees paid to insurance companyUSD $3,330
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,867,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,433
Amount paid for insurance broker fees3330
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberOH2355
Policy instance 1
Insurance contract or identification numberOH2355
Number of Individuals Covered129
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $3,230
Total amount of fees paid to insurance companyUSD $46
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $57,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,230
Amount paid for insurance broker fees46
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberOH2355
Policy instance 2
Insurance contract or identification numberOH2355
Number of Individuals Covered176
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $62,593
Total amount of fees paid to insurance companyUSD $890
Welfare Benefit Premiums Paid to CarrierUSD $1,116,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,593
Amount paid for insurance broker fees890
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberOH2355
Policy instance 1
Insurance contract or identification numberOH2355
Number of Individuals Covered135
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $2,378
Total amount of fees paid to insurance companyUSD $152
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $59,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,378
Amount paid for insurance broker fees152
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberOH2355
Policy instance 2
Insurance contract or identification numberOH2355
Number of Individuals Covered171
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $44,631
Total amount of fees paid to insurance companyUSD $2,848
Welfare Benefit Premiums Paid to CarrierUSD $1,111,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,631
Amount paid for insurance broker fees2848
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00497849
Policy instance 1
Insurance contract or identification number00497849
Number of Individuals Covered149
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $9,093
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $110,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,093
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00497849
Policy instance 1
Insurance contract or identification number00497849
Number of Individuals Covered120
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $7,291
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $78,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,148
Insurance broker nameLUCIDO MORRIS ASSOCIATES LLC

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