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| Plan Name | 5 STAR TEAM LEASING GROUP HEALTH PLAN |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | 5 STAR TEAM LEASING, L.L.C |
| Employer identification number (EIN): | 383441229 |
| NAIC Classification: | 441110 |
| NAIC Description: | New Car Dealers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2018-03-01 |
| Measure | Date | Value |
|---|---|---|
| 2018: 5 STAR TEAM LEASING GROUP HEALTH PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-03-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 22 |
| Number of retired or separated participants receiving benefits | 2018-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-03-01 | 0 |
| Total of all active and inactive participants | 2018-03-01 | 22 |
| Number of employers contributing to the scheme | 2018-03-01 | 0 |
| 2018: 5 STAR TEAM LEASING GROUP HEALTH PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | First time form 5500 has been submitted | Yes |
| 2018-03-01 | This submission is the final filing | Yes |
| 2018-03-01 | Plan funding arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) | |
| Policy contract number | 792461 |
| Policy instance | 1 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 2436 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 99032381001 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | R0533836 |
| Policy instance | 4 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 0010147255 |
| Policy instance | 5 |
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