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EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 401k Plan overview

Plan NameEMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC.
Plan identification number 502

EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

AMPM ENTERPRISES INC. has sponsored the creation of one or more 401k plans.

Company Name:AMPM ENTERPRISES INC.
Employer identification number (EIN):411821720
NAIC Classification:722513
NAIC Description:Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022018-05-01
5022017-05-01ANITA MEHTA
5022016-05-01ANITA MEHTA
5022015-05-01ANITA MEHTA
5022014-05-01ANITA MEHTA
5022013-05-01ANITA MEHTA
5022012-05-01ANITA MEHTA
5022011-05-01ANITA MEHTA
5022010-05-01ANITA MEHTA

Plan Statistics for EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC.

401k plan membership statisitcs for EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC.

Measure Date Value
2018: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2018 401k membership
Total participants, beginning-of-year2018-05-0139
Total number of active participants reported on line 7a of the Form 55002018-05-0113
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-0113
2017: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2017 401k membership
Total participants, beginning-of-year2017-05-0191
Total number of active participants reported on line 7a of the Form 55002017-05-0153
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-0153
2016: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2016 401k membership
Total participants, beginning-of-year2016-05-0155
Total number of active participants reported on line 7a of the Form 55002016-05-0147
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-0147
2015: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2015 401k membership
Total participants, beginning-of-year2015-05-0127
Total number of active participants reported on line 7a of the Form 55002015-05-0127
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-0127
2014: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2014 401k membership
Total participants, beginning-of-year2014-05-0120
Total number of active participants reported on line 7a of the Form 55002014-05-0116
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-0116
2013: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2013 401k membership
Total participants, beginning-of-year2013-05-0117
Total number of active participants reported on line 7a of the Form 55002013-05-0115
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-0115
2012: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2012 401k membership
Total participants, beginning-of-year2012-05-0123
Total number of active participants reported on line 7a of the Form 55002012-05-0117
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-0117
2011: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2011 401k membership
Total participants, beginning-of-year2011-05-0126
Total number of active participants reported on line 7a of the Form 55002011-05-0123
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-0123
2010: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2010 401k membership
Total participants, beginning-of-year2010-05-0129
Total number of active participants reported on line 7a of the Form 55002010-05-0126
Number of retired or separated participants receiving benefits2010-05-010
Number of other retired or separated participants entitled to future benefits2010-05-010
Total of all active and inactive participants2010-05-0126

Financial Data on EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC.

Measure Date Value
2018 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2018 401k financial data
Total plan liabilities at end of year2018-04-30$0
Total plan liabilities at beginning of year2018-04-30$0
Total income from all sources2018-04-30$335,524
Expenses. Total of all expenses incurred2018-04-30$279,962
Benefits paid (including direct rollovers)2018-04-30$97,622
Total plan assets at end of year2018-04-30$55,562
Total plan assets at beginning of year2018-04-30$0
Value of fidelity bond covering the plan2018-04-30$25,000
Expenses. Other expenses not covered elsewhere2018-04-30$182,340
Net income (gross income less expenses)2018-04-30$55,562
Net plan assets at end of year (total assets less liabilities)2018-04-30$55,562
Net plan assets at beginning of year (total assets less liabilities)2018-04-30$0
Total contributions received or receivable from employer(s)2018-04-30$335,524
2017 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2017 401k financial data
Total plan liabilities at end of year2017-04-30$0
Total plan liabilities at beginning of year2017-04-30$0
Total income from all sources2017-04-30$232,765
Expenses. Total of all expenses incurred2017-04-30$232,765
Benefits paid (including direct rollovers)2017-04-30$104,045
Total plan assets at end of year2017-04-30$0
Total plan assets at beginning of year2017-04-30$0
Value of fidelity bond covering the plan2017-04-30$25,000
Expenses. Other expenses not covered elsewhere2017-04-30$128,720
Net income (gross income less expenses)2017-04-30$0
Net plan assets at end of year (total assets less liabilities)2017-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2017-04-30$0
Total contributions received or receivable from employer(s)2017-04-30$232,765
2016 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2016 401k financial data
Total plan liabilities at end of year2016-04-30$0
Total plan liabilities at beginning of year2016-04-30$1,795
Total income from all sources2016-04-30$163,484
Expenses. Total of all expenses incurred2016-04-30$163,484
Benefits paid (including direct rollovers)2016-04-30$74,214
Total plan assets at end of year2016-04-30$0
Total plan assets at beginning of year2016-04-30$1,795
Value of fidelity bond covering the plan2016-04-30$20,000
Expenses. Other expenses not covered elsewhere2016-04-30$89,270
Net income (gross income less expenses)2016-04-30$0
Net plan assets at end of year (total assets less liabilities)2016-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2016-04-30$0
Total contributions received or receivable from employer(s)2016-04-30$163,484
2015 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2015 401k financial data
Total plan liabilities at end of year2015-04-30$1,795
Total plan liabilities at beginning of year2015-04-30$3,354
Total income from all sources2015-04-30$115,837
Expenses. Total of all expenses incurred2015-04-30$115,837
Benefits paid (including direct rollovers)2015-04-30$52,125
Total plan assets at end of year2015-04-30$1,795
Total plan assets at beginning of year2015-04-30$3,354
Value of fidelity bond covering the plan2015-04-30$25,000
Expenses. Other expenses not covered elsewhere2015-04-30$63,712
Net income (gross income less expenses)2015-04-30$0
Net plan assets at end of year (total assets less liabilities)2015-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2015-04-30$0
Total contributions received or receivable from employer(s)2015-04-30$115,837
2014 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2014 401k financial data
Total plan liabilities at end of year2014-04-30$3,354
Total plan liabilities at beginning of year2014-04-30$2,180
Total income from all sources2014-04-30$103,129
Expenses. Total of all expenses incurred2014-04-30$103,129
Benefits paid (including direct rollovers)2014-04-30$42,831
Total plan assets at end of year2014-04-30$3,354
Total plan assets at beginning of year2014-04-30$2,180
Value of fidelity bond covering the plan2014-04-30$25,000
Expenses. Other expenses not covered elsewhere2014-04-30$60,298
Net income (gross income less expenses)2014-04-30$0
Net plan assets at end of year (total assets less liabilities)2014-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2014-04-30$0
Total contributions received or receivable from employer(s)2014-04-30$103,129
2013 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2013 401k financial data
Total plan liabilities at end of year2013-04-30$2,180
Total plan liabilities at beginning of year2013-04-30$7,095
Total income from all sources2013-04-30$114,441
Expenses. Total of all expenses incurred2013-04-30$114,441
Benefits paid (including direct rollovers)2013-04-30$55,803
Total plan assets at end of year2013-04-30$2,180
Total plan assets at beginning of year2013-04-30$7,095
Expenses. Other expenses not covered elsewhere2013-04-30$58,638
Net income (gross income less expenses)2013-04-30$0
Net plan assets at end of year (total assets less liabilities)2013-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2013-04-30$0
Total contributions received or receivable from employer(s)2013-04-30$114,441
2012 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2012 401k financial data
Total plan liabilities at end of year2012-04-30$7,095
Total plan liabilities at beginning of year2012-04-30$6,257
Total income from all sources2012-04-30$162,884
Expenses. Total of all expenses incurred2012-04-30$162,884
Benefits paid (including direct rollovers)2012-04-30$78,238
Total plan assets at end of year2012-04-30$7,095
Total plan assets at beginning of year2012-04-30$6,257
Expenses. Other expenses not covered elsewhere2012-04-30$84,646
Net income (gross income less expenses)2012-04-30$0
Net plan assets at end of year (total assets less liabilities)2012-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2012-04-30$0
Total contributions received or receivable from employer(s)2012-04-30$162,884
2011 : EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2011 401k financial data
Total plan liabilities at end of year2011-04-30$6,257
Total plan liabilities at beginning of year2011-04-30$0
Total income from all sources2011-04-30$145,091
Expenses. Total of all expenses incurred2011-04-30$145,091
Benefits paid (including direct rollovers)2011-04-30$74,061
Total plan assets at end of year2011-04-30$6,257
Total plan assets at beginning of year2011-04-30$0
Expenses. Other expenses not covered elsewhere2011-04-30$71,030
Net income (gross income less expenses)2011-04-30$0
Net plan assets at end of year (total assets less liabilities)2011-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2011-04-30$0
Total contributions received or receivable from employer(s)2011-04-30$145,091

Form 5500 Responses for EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC.

2018: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan funding arrangement – TrustYes
2018-05-01Plan benefit arrangement – InsuranceYes
2018-05-01Plan benefit arrangement - TrustYes
2017: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan funding arrangement – TrustYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement - TrustYes
2016: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan funding arrangement – TrustYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement - TrustYes
2015: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan funding arrangement – TrustYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement - TrustYes
2014: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan funding arrangement – TrustYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement - TrustYes
2013: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan funding arrangement – TrustYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement - TrustYes
2012: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan funding arrangement – TrustYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement - TrustYes
2011: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan funding arrangement – TrustYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement - TrustYes
2010: EMPLOYEE HEALTH PLAN OF AMPM ENTERPRISES INC. 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01First time form 5500 has been submittedYes
2010-05-01Submission has been amendedNo
2010-05-01This submission is the final filingNo
2010-05-01This return/report is a short plan year return/report (less than 12 months)No
2010-05-01Plan is a collectively bargained planNo
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan funding arrangement – TrustYes
2010-05-01Plan benefit arrangement – InsuranceYes
2010-05-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered17
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
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 BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $88,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered79
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $140,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered51
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $66,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered39
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $48,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered24
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $43,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered27
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $40,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered37
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $58,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number13770 NFA 0171
Policy instance 1
Insurance contract or identification number13770 NFA 0171
Number of Individuals Covered38
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $56,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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