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FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 401k Plan overview

Plan NameFIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN
Plan identification number 501

FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

FIVE STAR/FIVE DIAMOND HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name:FIVE STAR/FIVE DIAMOND HOLDINGS, INC.
Employer identification number (EIN):273443226
NAIC Classification:812320
NAIC Description:Drycleaning and Laundry Services (except Coin-Operated)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-03-01
5012016-03-01
5012015-03-01
5012014-03-01CAROL TAYLOR CAROL TAYLOR2018-05-25
5012013-03-01CAROL TAYLOR CAROL TAYLOR2018-05-25
5012012-03-01CAROL TAYLOR CAROL TAYLOR2018-05-25
5012011-03-01CAROL TAYLOR CAROL TAYLOR2018-05-25

Plan Statistics for FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN

401k plan membership statisitcs for FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN

Measure Date Value
2017: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01259
Total number of active participants reported on line 7a of the Form 55002017-03-01259
Total of all active and inactive participants2017-03-01259
Total participants2017-03-01259
2016: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-01257
Total number of active participants reported on line 7a of the Form 55002016-03-01259
Total of all active and inactive participants2016-03-01259
Total participants2016-03-01259
2015: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-01264
Total number of active participants reported on line 7a of the Form 55002015-03-01257
Total of all active and inactive participants2015-03-01257
Total participants2015-03-01257
2014: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-01253
Total number of active participants reported on line 7a of the Form 55002014-03-01264
Total of all active and inactive participants2014-03-01264
Total participants2014-03-01264
2013: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-01157
Total number of active participants reported on line 7a of the Form 55002013-03-01253
Total of all active and inactive participants2013-03-01253
Total participants2013-03-01253
2012: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-01156
Total number of active participants reported on line 7a of the Form 55002012-03-01157
Total of all active and inactive participants2012-03-01157
Total participants2012-03-01157
2011: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-01120
Total number of active participants reported on line 7a of the Form 55002011-03-01156
Total of all active and inactive participants2011-03-01156
Total participants2011-03-01156

Form 5500 Responses for FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN

2017: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Submission has been amendedNo
2017-03-01This submission is the final filingNo
2017-03-01This return/report is a short plan year return/report (less than 12 months)No
2017-03-01Plan is a collectively bargained planNo
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan funding arrangement – General assets of the sponsorYes
2017-03-01Plan benefit arrangement – InsuranceYes
2016: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingNo
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan funding arrangement – General assets of the sponsorYes
2016-03-01Plan benefit arrangement – InsuranceYes
2015: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)No
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan funding arrangement – General assets of the sponsorYes
2015-03-01Plan benefit arrangement – InsuranceYes
2014: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Submission has been amendedNo
2014-03-01This submission is the final filingNo
2014-03-01This return/report is a short plan year return/report (less than 12 months)No
2014-03-01Plan is a collectively bargained planNo
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan funding arrangement – General assets of the sponsorYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Submission has been amendedNo
2013-03-01This submission is the final filingNo
2013-03-01This return/report is a short plan year return/report (less than 12 months)No
2013-03-01Plan is a collectively bargained planNo
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan funding arrangement – General assets of the sponsorYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Submission has been amendedNo
2012-03-01This submission is the final filingNo
2012-03-01This return/report is a short plan year return/report (less than 12 months)No
2012-03-01Plan is a collectively bargained planNo
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan funding arrangement – General assets of the sponsorYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: FIVE STAR FIVE DIAMOND HOLDINGS MEDICAL LIFE AND ADD PLAN 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01First time form 5500 has been submittedYes
2011-03-01Submission has been amendedNo
2011-03-01This submission is the final filingNo
2011-03-01This return/report is a short plan year return/report (less than 12 months)No
2011-03-01Plan is a collectively bargained planNo
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan funding arrangement – General assets of the sponsorYes
2011-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number754027
Policy instance 1
Insurance contract or identification number754027
Number of Individuals Covered259
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $673
Total amount of fees paid to insurance companyUSD $25,797
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $612,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $337
Amount paid for insurance broker fees12929
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameCOORDINATED BENEFITS COMPANY LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number754027
Policy instance 1
Insurance contract or identification number754027
Number of Individuals Covered253
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $39,956
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $989,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,956
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number471074
Policy instance 1
Insurance contract or identification number471074
Number of Individuals Covered157
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $539
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $556,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $539
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number471074
Policy instance 1
Insurance contract or identification number471074
Number of Individuals Covered156
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $2,013
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $617,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,013
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP INC

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