401k Plan data: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN plan

KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number	501

KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE 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) Other welfare benefit cover

401k Sponsoring company profile

KIRBY NAGELHOUT CONSTRUCTION CO. has sponsored the creation of one or more 401k plans.

Company Name: KIRBY NAGELHOUT CONSTRUCTION CO.

Employer identification number (EIN): 931129077

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-09-01 JEFF DESWERT 2024-01-12
501 2021-09-01 GAYLE STEINDORF 2023-02-09
501 2020-09-01 GAYLE STEINDORF 2022-03-22
501 2019-09-01 LINDA BAUER 2021-04-14
501 2009-01-01 STEPHEN MOOR
501 2009-01-01 STEPHEN MOOR
501 2009-01-01 STEPHEN MOOR

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-09-01	JEFF DESWERT	2024-01-12
501	2021-09-01	GAYLE STEINDORF	2023-02-09
501	2020-09-01	GAYLE STEINDORF	2022-03-22
501	2019-09-01	LINDA BAUER	2021-04-14
501	2009-01-01	STEPHEN MOOR
501	2009-01-01	STEPHEN MOOR
501	2009-01-01	STEPHEN MOOR

Plan Statistics for KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2022: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-09-01 138
Total number of active participants reported on line 7a of the Form 5500 2022-09-01 120
Number of retired or separated participants receiving benefits 2022-09-01 0
Number of other retired or separated participants entitled to future benefits 2022-09-01 0
Total of all active and inactive participants 2022-09-01 120
Number of employers contributing to the scheme 2022-09-01 0
2021: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-09-01 125
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 138
Number of retired or separated participants receiving benefits 2021-09-01 0
Number of other retired or separated participants entitled to future benefits 2021-09-01 0
Total of all active and inactive participants 2021-09-01 138
Number of employers contributing to the scheme 2021-09-01 0
2020: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-09-01 115
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 125
Number of retired or separated participants receiving benefits 2020-09-01 0
Number of other retired or separated participants entitled to future benefits 2020-09-01 0
Total of all active and inactive participants 2020-09-01 125
Number of employers contributing to the scheme 2020-09-01 0
2019: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 110
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 115
Number of retired or separated participants receiving benefits 2019-09-01 0
Number of other retired or separated participants entitled to future benefits 2019-09-01 0
Total of all active and inactive participants 2019-09-01 115
Number of employers contributing to the scheme 2019-09-01 0
2009: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 233
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 233

Measure	Date	Value
2022: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-09-01	138
Total number of active participants reported on line 7a of the Form 5500	2022-09-01	120
Number of retired or separated participants receiving benefits	2022-09-01	0
Number of other retired or separated participants entitled to future benefits	2022-09-01	0
Total of all active and inactive participants	2022-09-01	120
Number of employers contributing to the scheme	2022-09-01	0
2021: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	125
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	138
Number of retired or separated participants receiving benefits	2021-09-01	0
Number of other retired or separated participants entitled to future benefits	2021-09-01	0
Total of all active and inactive participants	2021-09-01	138
Number of employers contributing to the scheme	2021-09-01	0
2020: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	115
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	125
Number of retired or separated participants receiving benefits	2020-09-01	0
Number of other retired or separated participants entitled to future benefits	2020-09-01	0
Total of all active and inactive participants	2020-09-01	125
Number of employers contributing to the scheme	2020-09-01	0
2019: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	110
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	115
Number of retired or separated participants receiving benefits	2019-09-01	0
Number of other retired or separated participants entitled to future benefits	2019-09-01	0
Total of all active and inactive participants	2019-09-01	115
Number of employers contributing to the scheme	2019-09-01	0
2009: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	233
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	233

Form 5500 Responses for KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN

2022: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-09-01	Type of plan entity	Single employer plan
2022-09-01	Plan funding arrangement – Insurance	Yes
2022-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-09-01	Plan benefit arrangement – Insurance	Yes
2022-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: KIRBY NAGELHOUT CONSTRUCTION EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

MEDICAL AIR SERVICES ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 62191 )
Policy contract number	B2BKNCC
Policy instance	4
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	FK055
Policy instance	3
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR300983
Policy instance	2
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	119653
Policy instance	1
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	119653
Policy instance	1
MEDICAL AIR SERVICES ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 62191 )
Policy contract number	B2BKNCC
Policy instance	5
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	FK055
Policy instance	4
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR300983
Policy instance	3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	758553
Policy instance	2
MEDICAL AIR SERVICES ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 62191 )
Policy contract number	B2BKNCC
Policy instance	5
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	FK055
Policy instance	4
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR300983
Policy instance	3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	758553
Policy instance	2
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	119653
Policy instance	1
MEDICAL AIR SERVICES ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 62191 )
Policy contract number	B2BKNCC
Policy instance	5
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	FK055
Policy instance	4
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR300983
Policy instance	3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	758553
Policy instance	2
PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )
Policy contract number	G0031972
Policy instance	1

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Company Name:	KIRBY NAGELHOUT CONSTRUCTION CO.
Employer identification number (EIN):	931129077
NAIC Classification:	236200