401k Plan data: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN plan

THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN
Plan identification number	501

THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED has sponsored the creation of one or more 401k plans.

Company Name: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED

Employer identification number (EIN): 561214816

NAIC Classification: 541330
NAIC Description: Engineering Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-05-01
501 2021-05-01

Plan Statistics for THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN

401k plan membership statisitcs for THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN

Measure Date Value
2022: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-05-01 106
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 109
Total of all active and inactive participants 2022-05-01 109
2021: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-05-01 102
Total number of active participants reported on line 7a of the Form 5500 2021-05-01 106
Total of all active and inactive participants 2021-05-01 106

Measure	Date	Value
2022: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-05-01	106
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	109
Total of all active and inactive participants	2022-05-01	109
2021: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-05-01	102
Total number of active participants reported on line 7a of the Form 5500	2021-05-01	106
Total of all active and inactive participants	2021-05-01	106

Form 5500 Responses for THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN

2022: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes
2021: THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	First time form 5500 has been submitted	Yes
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

007306

Policy instance

Insurance contract or identification number	007306
Number of Individuals Covered	109
Insurance policy start date	2022-02-01
Insurance policy end date	2023-02-01
Total amount of commissions paid to insurance broker	USD $24,416
Total amount of fees paid to insurance company	USD $9,925
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP LIFE
Commission paid to Insurance Broker	USD $24,416
Insurance broker organization code?	3
Amount paid for insurance broker fees	9925

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

Policy contract number

Policy instance

Number of Individuals Covered	83
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $25,661
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $25,661
Insurance broker organization code?	3

COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

Policy instance

Number of Individuals Covered	100
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $1,827
Vision Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $1,827
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

007306

Policy instance

Insurance contract or identification number	007306
Number of Individuals Covered	102
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-01
Total amount of commissions paid to insurance broker	USD $22,322
Total amount of fees paid to insurance company	USD $9,150
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	GROUP LIFE
Commission paid to Insurance Broker	USD $22,322
Insurance broker organization code?	3
Amount paid for insurance broker fees	9150

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

Policy contract number

Policy instance

Number of Individuals Covered	79
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $22,861
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $22,861
Insurance broker organization code?	3

COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

Policy instance

Number of Individuals Covered	98
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $1,779
Vision Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $1,779
Insurance broker organization code?	3

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Company Name:	THOMPSON-GORDON-SHOOK ENGINEERS, INCORPORATED
Employer identification number (EIN):	561214816
NAIC Classification:	541330
NAIC Description:	Engineering Services