401k Plan data: THE ROARK GROUP plan

THE ROARK GROUP 401k Plan overview

Plan Name	THE ROARK GROUP
Plan identification number	502

THE ROARK GROUP 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

THE ROARK GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE ROARK GROUP, INC.

Employer identification number (EIN): 710454445

NAIC Classification: 323100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE ROARK GROUP

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-12-01 STEVE STANBERRY 2024-06-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2022-12-01	STEVE STANBERRY	2024-06-21

Plan Statistics for THE ROARK GROUP

401k plan membership statisitcs for THE ROARK GROUP

Measure Date Value
2022: THE ROARK GROUP 2022 401k membership
Total participants, beginning-of-year 2022-12-01 164
Total number of active participants reported on line 7a of the Form 5500 2022-12-01 271
Number of retired or separated participants receiving benefits 2022-12-01 2
Number of other retired or separated participants entitled to future benefits 2022-12-01 1
Total of all active and inactive participants 2022-12-01 274
Number of employers contributing to the scheme 2022-12-01 0

Measure	Date	Value
2022: THE ROARK GROUP 2022 401k membership
Total participants, beginning-of-year	2022-12-01	164
Total number of active participants reported on line 7a of the Form 5500	2022-12-01	271
Number of retired or separated participants receiving benefits	2022-12-01	2
Number of other retired or separated participants entitled to future benefits	2022-12-01	1
Total of all active and inactive participants	2022-12-01	274
Number of employers contributing to the scheme	2022-12-01	0

Form 5500 Responses for THE ROARK GROUP

2022: THE ROARK GROUP 2022 form 5500 responses
2022-12-01	Type of plan entity	Single employer plan
2022-12-01	First time form 5500 has been submitted	Yes
2022-12-01	Plan funding arrangement – Insurance	Yes
2022-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-12-01	Plan benefit arrangement – Insurance	Yes
2022-12-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

029615/029617

Policy instance

Insurance contract or identification number	029615/029617
Number of Individuals Covered	207
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

4779

Policy instance

Insurance contract or identification number	4779
Number of Individuals Covered	193
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $5,759
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,759
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

4779V

Policy instance

Insurance contract or identification number	4779V
Number of Individuals Covered	165
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $1,329
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,329
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

164958

Policy instance

Insurance contract or identification number	164958
Number of Individuals Covered	58
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $5,108
Total amount of fees paid to insurance company	USD $1,144
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 $41,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,108
Amount paid for insurance broker fees	560
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50052025

Policy instance

Insurance contract or identification number	50052025
Number of Individuals Covered	152
Insurance policy start date	2023-01-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $1,095
Total amount of fees paid to insurance company	USD $0
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	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,CANCER
Welfare Benefit Premiums Paid to Carrier	USD $6,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $673
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	THE ROARK GROUP, INC.
Employer identification number (EIN):	710454445
NAIC Classification:	323100