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| Plan Name | GROOME INDUSTRIAL SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GROOME INDUSTRIAL SERVICE GROUP, LLC |
| Employer identification number (EIN): | 843030321 |
| NAIC Classification: | 541990 |
| NAIC Description: | All Other Professional, Scientific, and Technical Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-06-01 | JOANNE LUTZ | 2024-12-19 | ||
| 501 | 2022-06-01 | JOANNE LUTZ | 2023-10-19 |
| 2023: GROOME INDUSTRIAL SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-06-01 | Type of plan entity | Single employer plan |
| 2023-06-01 | Plan funding arrangement – Insurance | Yes |
| 2023-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: GROOME INDUSTRIAL SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2022 form 5500 responses | ||
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | First time form 5500 has been submitted | Yes |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | PZP77 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 650319 | ||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 1D041948 | ||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | PZP77 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 1D041948 | ||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||
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