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| Plan Name | ALEXANDER & RAY'S TV & APPLIANCE SELF-FUNDED MEDICAL REIMBURSEMENT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ALEXANDER & RAY'S TV & APPLIANCE |
| Employer identification number (EIN): | 481134608 |
| NAIC Classification: | 443141 |
| NAIC Description: | Household Appliance Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-02-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: ALEXANDER & RAY'S TV & APPLIANCE SELF-FUNDED MEDICAL REIMBURSEMENT PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-02-01 | 4 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 5 |
| Number of retired or separated participants receiving benefits | 2022-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
| Total of all active and inactive participants | 2022-02-01 | 5 |
| Measure | Date | Value |
|---|---|---|
| 2023 : ALEXANDER & RAY'S TV & APPLIANCE SELF-FUNDED MEDICAL REIMBURSEMENT PLAN 2023 401k financial data | ||
| Total income from all sources | 2023-01-31 | $20,637 |
| Expenses. Total of all expenses incurred | 2023-01-31 | $5,697 |
| Benefits paid (including direct rollovers) | 2023-01-31 | $1,380 |
| Total plan assets at end of year | 2023-01-31 | $14,940 |
| Total plan assets at beginning of year | 2023-01-31 | $0 |
| Other income received | 2023-01-31 | $224 |
| Net income (gross income less expenses) | 2023-01-31 | $14,940 |
| Net plan assets at end of year (total assets less liabilities) | 2023-01-31 | $14,940 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2023-01-31 | $20,413 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-01-31 | $4,317 |
| 2022: ALEXANDER & RAY'S TV & APPLIANCE SELF-FUNDED MEDICAL REIMBURSEMENT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | First time form 5500 has been submitted | Yes |
| 2022-02-01 | Plan funding arrangement – Trust | Yes |
| 2022-02-01 | Plan benefit arrangement - Trust | Yes |
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