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ERBE USA GROUP HEALTH PLAN 401k Plan overview

Plan NameERBE USA GROUP HEALTH PLAN
Plan identification number 501

ERBE USA 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
  • Severance pay
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ERBE USA, INCORPORATED has sponsored the creation of one or more 401k plans.

Company Name:ERBE USA, INCORPORATED
Employer identification number (EIN):581998374
NAIC Classification:446190

Additional information about ERBE USA, INCORPORATED

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date: 1992-10-16
Company Identification Number: 860718
Legal Registered Office Address: 2225 Northwest Parkway

Marietta
United States of America (USA)
30067

More information about ERBE USA, INCORPORATED

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ERBE USA GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01DERRICK W. ROY2024-06-04
5012022-01-01DERRICK W ROY2023-09-13
5012020-01-01DERRICK W. ROY2021-08-16

Plan Statistics for ERBE USA GROUP HEALTH PLAN

401k plan membership statisitcs for ERBE USA GROUP HEALTH PLAN

Measure Date Value
2023: ERBE USA GROUP HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01183
Total number of active participants reported on line 7a of the Form 55002023-01-01263
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01263
Number of employers contributing to the scheme2023-01-010
2022: ERBE USA GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01100
Total number of active participants reported on line 7a of the Form 55002022-01-01181
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01183
Number of employers contributing to the scheme2022-01-010
2020: ERBE USA GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01102
Total number of active participants reported on line 7a of the Form 55002020-01-0198
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0199
Number of employers contributing to the scheme2020-01-010

Form 5500 Responses for ERBE USA GROUP HEALTH PLAN

2023: ERBE USA GROUP HEALTH PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: ERBE USA GROUP HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: ERBE USA GROUP HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan 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 number3333491
Policy instance 1
Insurance contract or identification number3333491
Number of Individuals Covered231
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $22,234
Total amount of fees paid to insurance companyUSD $195,570
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,443,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM0609252
Policy instance 2
Insurance contract or identification numberSGM0609252
Number of Individuals Covered263
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $23,502
Total amount of fees paid to insurance companyUSD $4,566
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 providedEMPLOYEE ASSISTANCE PROGRAM,ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $168,446
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 number3333491
Policy instance 1
Insurance contract or identification number3333491
Number of Individuals Covered181
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $18,627
Total amount of fees paid to insurance companyUSD $153,012
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,737,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,627
Amount paid for insurance broker fees153012
Additional information about fees paid to insurance brokerBENEFIT ADVISOR PAYMENTS
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM609252
Policy instance 2
Insurance contract or identification numberSGM609252
Number of Individuals Covered119
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $23,750
Total amount of fees paid to insurance companyUSD $2,745
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 providedEMPLOYEE ASSISTANCE PROGRAM,ACCIDENT,ACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $164,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,750
Amount paid for insurance broker fees2745
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM609252
Policy instance 1
Insurance contract or identification numberSGM609252
Number of Individuals Covered98
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,519
Total amount of fees paid to insurance companyUSD $667
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,519
Amount paid for insurance broker fees667
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3

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