401k Plan data: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN plan

THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 401k Plan overview

Plan Name	THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN
Plan identification number	501

THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness)

401k Sponsoring company profile

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

Company Name: THE HAMSTRA GROUP INC.

Employer identification number (EIN): 351110806

NAIC Classification: 236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MITCH VAN KLEY 2024-09-18
501 2022-01-01 MITCH VAN KLEY 2023-10-13
501 2021-01-01 MITCH VAN KLEY 2022-06-14
501 2020-01-01 MITCH VAN KLEY 2021-07-15
501 2019-01-01
501 2018-01-01 MITCHELL H VAN KLEY MITCHELL H VAN KLEY 2019-06-08
501 2017-01-01 MITCHELL H VAN KLEY MITCHELL H VAN KLEY 2018-05-18
501 2016-01-01 MITCH VAN KLEY MITCH VAN KLEY 2017-07-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	MITCH VAN KLEY	2024-09-18
501	2022-01-01	MITCH VAN KLEY	2023-10-13
501	2021-01-01	MITCH VAN KLEY	2022-06-14
501	2020-01-01	MITCH VAN KLEY	2021-07-15
501	2019-01-01
501	2018-01-01	MITCHELL H VAN KLEY		MITCHELL H VAN KLEY	2019-06-08
501	2017-01-01	MITCHELL H VAN KLEY		MITCHELL H VAN KLEY	2018-05-18
501	2016-01-01	MITCH VAN KLEY		MITCH VAN KLEY	2017-07-06

Form 5500 Responses for THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN

2023: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: THE HAMSTRA GROUP INC., GROUP HEALTH AND DENTAL PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

218087

Policy instance

Insurance contract or identification number	218087
Number of Individuals Covered	100
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,345
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

218087

Policy instance

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Company Name:	THE HAMSTRA GROUP INC.
Employer identification number (EIN):	351110806
NAIC Classification:	236110