| Plan Name | PEACH STATE ROOFING EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | PEACH STATE ROOFING |
| Employer identification number (EIN): | 581920786 |
| NAIC Classification: | 238100 |
Additional information about PEACH STATE ROOFING
| Jurisdiction of Incorporation: | Texas Secretary of State |
| Incorporation Date: | 2001-01-05 |
| Company Identification Number: | 0013646006 |
| Legal Registered Office Address: |
1655 SPECTRUM DR STE A LAWRENCEVILLE United States of America (USA) 30043 |
More information about PEACH STATE ROOFING
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-08-01 | KRISTEN KELLY | |||
| 501 | 2021-08-01 | ||||
| 501 | 2021-08-01 | KRISTEN KELLY | |||
| 501 | 2020-08-01 | ||||
| 501 | 2019-08-01 |
| 2021: PEACH STATE ROOFING EMPLOYEE BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-08-01 | Type of plan entity | Mulitple employer plan |
| 2021-08-01 | Submission has been amended | No |
| 2021-08-01 | This submission is the final filing | No |
| 2021-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-08-01 | Plan is a collectively bargained plan | No |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: PEACH STATE ROOFING EMPLOYEE BENEFIT PLAN 2020 form 5500 responses | ||
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Submission has been amended | No |
| 2020-08-01 | This submission is the final filing | No |
| 2020-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-08-01 | Plan is a collectively bargained plan | No |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: PEACH STATE ROOFING EMPLOYEE BENEFIT PLAN 2019 form 5500 responses | ||
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | First time form 5500 has been submitted | Yes |
| 2019-08-01 | Submission has been amended | No |
| 2019-08-01 | This submission is the final filing | No |
| 2019-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-08-01 | Plan is a collectively bargained plan | No |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) | |
| Policy contract number | G00617360 |
| Policy instance | 1 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 00633232 |
| Policy instance | 2 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00023525 |
| Policy instance | 3 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) | |
| Policy contract number | G00617360 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |
| Policy contract number | GB0161 |
| Policy instance | 2 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) | |
| Policy contract number | G00617360 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |
| Policy contract number | GB0161 |
| Policy instance | 2 |