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| Plan Name | H.A. SACK HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | H.A. SACK, INC. |
| Employer identification number (EIN): | 580709776 |
| NAIC Classification: | 238290 |
| NAIC Description: | Other Building Equipment Contractors |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-04-01 | FRED HILL | 2024-10-15 | ||
| 501 | 2022-04-01 | ||||
| 501 | 2021-04-01 |
| Measure | Date | Value |
|---|---|---|
| 2023: H.A. SACK HEALTH AND WELFARE PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-04-01 | 223 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-04-01 | 215 |
| Number of retired or separated participants receiving benefits | 2023-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-04-01 | 0 |
| Total of all active and inactive participants | 2023-04-01 | 215 |
| 2022: H.A. SACK HEALTH AND WELFARE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-04-01 | 223 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 259 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
| Total of all active and inactive participants | 2022-04-01 | 259 |
| 2021: H.A. SACK HEALTH AND WELFARE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-04-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 212 |
| Number of retired or separated participants receiving benefits | 2021-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
| Total of all active and inactive participants | 2021-04-01 | 212 |
| 2023: H.A. SACK HEALTH AND WELFARE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-04-01 | Type of plan entity | Single employer plan |
| 2023-04-01 | Submission has been amended | No |
| 2023-04-01 | This submission is the final filing | No |
| 2023-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-04-01 | Plan is a collectively bargained plan | No |
| 2023-04-01 | Plan funding arrangement – Insurance | Yes |
| 2023-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: H.A. SACK HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Submission has been amended | No |
| 2022-04-01 | This submission is the final filing | No |
| 2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-04-01 | Plan is a collectively bargained plan | No |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: H.A. SACK HEALTH AND WELFARE PLAN 2021 form 5500 responses | ||
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | First time form 5500 has been submitted | Yes |
| 2021-04-01 | Submission has been amended | No |
| 2021-04-01 | This submission is the final filing | No |
| 2021-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-04-01 | Plan is a collectively bargained plan | No |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GA7151 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GA7151 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GA7151 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GA7151 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GA7151 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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