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| Plan Name | FILTERWORKS USA LLC WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FILTERWORKS USA, LLC |
| Employer identification number (EIN): | 832624280 |
| NAIC Classification: | 423400 |
Additional information about FILTERWORKS USA, LLC
| Jurisdiction of Incorporation: | Florida Department of State Division of Corporations |
| Incorporation Date: | 2018-11-21 |
| Company Identification Number: | L18000270208 |
| Legal Registered Office Address: |
1201 HAYS STREET TALLAHASSEE 32301 |
More information about FILTERWORKS USA, LLC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-06-01 | ||||
| 501 | 2021-06-01 | JASON FREDRICK |
| 2021: FILTERWORKS USA LLC WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | First time form 5500 has been submitted | Yes |
| 2021-06-01 | Submission has been amended | No |
| 2021-06-01 | This submission is the final filing | No |
| 2021-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-06-01 | Plan is a collectively bargained plan | No |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 ) | |
| Policy contract number | 100748 |
| Policy instance | 1 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E5669718 |
| Policy instance | 2 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 00632854 |
| Policy instance | 3 |
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