401k Plan data: SHELBY ERECTORS 401(K) PLAN plan

SHELBY ERECTORS 401(K) PLAN 401k Plan overview

Plan Name	SHELBY ERECTORS 401(K) PLAN
Plan identification number	001

SHELBY ERECTORS 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SHELBY ERECTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name: SHELBY ERECTORS, INC.

Employer identification number (EIN): 650755020

NAIC Classification: 238100

Additional information about SHELBY ERECTORS, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1997-04-21

Company Identification Number: P97000036082

Legal Registered Office Address: 4575 Oakes Road

Davie

33314

More information about SHELBY ERECTORS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHELBY ERECTORS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01 JENNIFER NIX 2023-10-15
001 2021-01-01 DEBBIE FOTI 2022-10-16
001 2020-01-01
001 2019-01-01 REBECCA MARTIN 2020-10-09
001 2018-01-01 REBECCA MARTIN 2019-10-14 REBECCA MARTIN 2019-10-14
001 2017-01-01 STEVEN CERTAIN 2018-05-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01
001	2022-01-01	JENNIFER NIX	2023-10-15
001	2021-01-01	DEBBIE FOTI	2022-10-16
001	2020-01-01
001	2019-01-01	REBECCA MARTIN	2020-10-09
001	2018-01-01	REBECCA MARTIN	2019-10-14	REBECCA MARTIN	2019-10-14
001	2017-01-01	STEVEN CERTAIN	2018-05-25

Plan Statistics for SHELBY ERECTORS 401(K) PLAN

401k plan membership statisitcs for SHELBY ERECTORS 401(K) PLAN

Measure Date Value
2022: SHELBY ERECTORS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 82
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 24
Total of all active and inactive participants 2022-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 106
Number of participants with account balances 2022-01-01 65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 5
2021: SHELBY ERECTORS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 180
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 98
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 18
Total of all active and inactive participants 2021-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 116
Number of participants with account balances 2021-01-01 68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 4
2020: SHELBY ERECTORS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 174
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 10
Total of all active and inactive participants 2020-01-01 184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 184
Number of participants with account balances 2020-01-01 54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0

Measure	Date	Value
2022: SHELBY ERECTORS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	82
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	24
Total of all active and inactive participants	2022-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	106
Number of participants with account balances	2022-01-01	65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	5
2021: SHELBY ERECTORS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	180
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	98
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	18
Total of all active and inactive participants	2021-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	116
Number of participants with account balances	2021-01-01	68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	4
2020: SHELBY ERECTORS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	174
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	10
Total of all active and inactive participants	2020-01-01	184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	184
Number of participants with account balances	2020-01-01	54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0

Financial Data on SHELBY ERECTORS 401(K) PLAN

Measure	Date	Value
2022 : SHELBY ERECTORS 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$44,573
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$29,781
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$28,298
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$299,795
Value of total assets at end of year	2022-12-31	$1,453,785
Value of total assets at beginning of year	2022-12-31	$1,438,993
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$1,483
Total interest from all sources	2022-12-31	$4,264
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$204,350
Participant contributions at end of year	2022-12-31	$81,049
Participant contributions at beginning of year	2022-12-31	$67,851
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$14,792
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$1,453,785
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,438,993
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$1,369,380
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$1,338,393
Interest on participant loans	2022-12-31	$4,264
Net investment gain/loss from pooled separate accounts	2022-12-31	$-259,486
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$95,445
Employer contributions (assets) at end of year	2022-12-31	$3,356
Employer contributions (assets) at beginning of year	2022-12-31	$32,749
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$28,298
Contract administrator fees	2022-12-31	$1,483
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	FRSCPA
Accountancy firm EIN	2022-12-31	592482214
2021 : SHELBY ERECTORS 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$487,033
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$104,651
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$100,895
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$348,495
Value of total assets at end of year	2021-12-31	$1,438,993
Value of total assets at beginning of year	2021-12-31	$1,056,611
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$3,756
Total interest from all sources	2021-12-31	$4,362
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$3,576
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$216,381
Participant contributions at end of year	2021-12-31	$67,851
Participant contributions at beginning of year	2021-12-31	$63,981
Total non interest bearing cash at beginning of year	2021-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$382,382
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,438,993
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,056,611
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,338,393
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$941,462
Interest on participant loans	2021-12-31	$4,362
Net investment gain/loss from pooled separate accounts	2021-12-31	$134,176
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$132,114
Employer contributions (assets) at end of year	2021-12-31	$32,749
Employer contributions (assets) at beginning of year	2021-12-31	$51,168
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$100,895
Contract administrator fees	2021-12-31	$180
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	Yes
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	FRSCPA
Accountancy firm EIN	2021-12-31	592482214
2020 : SHELBY ERECTORS 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$450,739
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$53,868
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$46,085
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$347,193
Value of total assets at end of year	2020-12-31	$1,056,611
Value of total assets at beginning of year	2020-12-31	$659,740
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$7,783
Total interest from all sources	2020-12-31	$1,630
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$7,223
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$172,387
Participant contributions at end of year	2020-12-31	$63,981
Participant contributions at beginning of year	2020-12-31	$7,331
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$8,169
Total non interest bearing cash at end of year	2020-12-31	$0
Total non interest bearing cash at beginning of year	2020-12-31	$1,479
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$396,871
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,056,611
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$659,740
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$941,462
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$650,930
Interest on participant loans	2020-12-31	$1,630
Net investment gain/loss from pooled separate accounts	2020-12-31	$101,916
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$166,637
Employer contributions (assets) at end of year	2020-12-31	$51,168
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$46,085
Contract administrator fees	2020-12-31	$560
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	FRSCPA
Accountancy firm EIN	2020-12-31	592482214

Form 5500 Responses for SHELBY ERECTORS 401(K) PLAN

2022: SHELBY ERECTORS 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: SHELBY ERECTORS 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: SHELBY ERECTORS 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

81G943

Policy instance

Insurance contract or identification number	81G943
Number of Individuals Covered	66
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,950
Total amount of fees paid to insurance company	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,950
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

124849

Policy instance

Insurance contract or identification number	124849
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $718
Total amount of fees paid to insurance company	USD $308
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $718
Insurance broker organization code?	3
Amount paid for insurance broker fees	308
Additional information about fees paid to insurance broker	TPA FEES

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

81G943

Policy instance

Insurance contract or identification number	81G943
Number of Individuals Covered	68
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,800
Total amount of fees paid to insurance company	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,800
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

124849

Policy instance

Insurance contract or identification number	124849
Number of Individuals Covered	67
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,201
Total amount of fees paid to insurance company	USD $938
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,201
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	TPA FEES

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Company Name:	SHELBY ERECTORS, INC.
Employer identification number (EIN):	650755020
NAIC Classification:	238100

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1997-04-21
Company Identification Number:	P97000036082
Legal Registered Office Address:	4575 Oakes Road Davie 33314