401k Plan data: FIBERGLASS COATINGS, INC. BENEFIT PLAN plan

FIBERGLASS COATINGS, INC. BENEFIT PLAN 401k Plan overview

Plan Name	FIBERGLASS COATINGS, INC. BENEFIT PLAN
Plan identification number	501

FIBERGLASS COATINGS, INC. BENEFIT 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 Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

FIBERGLASS COATINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name: FIBERGLASS COATINGS, INC.

Employer identification number (EIN): 592987762

NAIC Classification: 424950
NAIC Description: Paint, Varnish, and Supplies Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIBERGLASS COATINGS, INC. BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-03-01 STEPHANIE DE LOS RIOS 2024-09-16
501 2022-03-01
501 2022-03-01 TINA CORTES
501 2021-03-01
501 2021-03-01
501 2021-03-01 TINA CORTES

Plan Statistics for FIBERGLASS COATINGS, INC. BENEFIT PLAN

401k plan membership statisitcs for FIBERGLASS COATINGS, INC. BENEFIT PLAN

Measure Date Value
2023: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-03-01 106
Total number of active participants reported on line 7a of the Form 5500 2023-03-01 102
Number of retired or separated participants receiving benefits 2023-03-01 0
Number of other retired or separated participants entitled to future benefits 2023-03-01 4
Total of all active and inactive participants 2023-03-01 106
Number of employers contributing to the scheme 2023-03-01 0
2022: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 79
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 79
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 79
2021: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-03-01 217
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 217
Number of retired or separated participants receiving benefits 2021-03-01 0
Number of other retired or separated participants entitled to future benefits 2021-03-01 0
Total of all active and inactive participants 2021-03-01 217

Measure	Date	Value
2023: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-03-01	106
Total number of active participants reported on line 7a of the Form 5500	2023-03-01	102
Number of retired or separated participants receiving benefits	2023-03-01	0
Number of other retired or separated participants entitled to future benefits	2023-03-01	4
Total of all active and inactive participants	2023-03-01	106
Number of employers contributing to the scheme	2023-03-01	0
2022: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	79
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	79
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	79
2021: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-03-01	217
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	217
Number of retired or separated participants receiving benefits	2021-03-01	0
Number of other retired or separated participants entitled to future benefits	2021-03-01	0
Total of all active and inactive participants	2021-03-01	217

Form 5500 Responses for FIBERGLASS COATINGS, INC. BENEFIT PLAN

2023: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2023 form 5500 responses
2023-03-01	Type of plan entity	Single employer plan
2023-03-01	Plan funding arrangement – Insurance	Yes
2023-03-01	Plan benefit arrangement – Insurance	Yes
2022: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Submission has been amended	No
2022-03-01	This submission is the final filing	No
2022-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-03-01	Plan is a collectively bargained plan	No
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2021: FIBERGLASS COATINGS, INC. BENEFIT PLAN 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	First time form 5500 has been submitted	Yes
2021-03-01	Submission has been amended	No
2021-03-01	This submission is the final filing	No
2021-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-03-01	Plan is a collectively bargained plan	No
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

855951

Policy instance

Insurance contract or identification number	855951
Number of Individuals Covered	53
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $3,487
Total amount of fees paid to insurance company	USD $1,583
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA MEDICAL PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95270 )

Policy contract number

855951

Policy instance

Insurance contract or identification number	855951
Number of Individuals Covered	77
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $38,504
Total amount of fees paid to insurance company	USD $669
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $592,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 )

Policy contract number

855951

Policy instance

Insurance contract or identification number	855951
Number of Individuals Covered	21
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $312
Total amount of fees paid to insurance company	USD $393
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BJ7W

Policy instance

Insurance contract or identification number	GLUG0BJ7W
Number of Individuals Covered	102
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $5,072
Total amount of fees paid to insurance company	USD $1,705
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $33,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

855951

Policy instance

Insurance contract or identification number	855951
Number of Individuals Covered	78
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $37,000
Total amount of fees paid to insurance company	USD $2,833
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $639,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0923904

Policy instance

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Company Name:	FIBERGLASS COATINGS, INC.
Employer identification number (EIN):	592987762
NAIC Classification:	424950
NAIC Description:	Paint, Varnish, and Supplies Merchant Wholesalers

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-03-01	STEPHANIE DE LOS RIOS	2024-09-16
501	2022-03-01
501	2022-03-01	TINA CORTES
501	2021-03-01
501	2021-03-01
501	2021-03-01	TINA CORTES