401k Plan data: YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN plan

YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN
Plan identification number	501

YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

YALE APPLIANCE AND LIGHTING has sponsored the creation of one or more 401k plans.

Company Name: YALE APPLIANCE AND LIGHTING

Employer identification number (EIN): 042457546

NAIC Classification: 443141
NAIC Description: Household Appliance Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2008-01-01 KAREN BEROLINI 2022-07-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2008-01-01	KAREN BEROLINI	2022-07-22

Plan Statistics for YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN

401k plan membership statisitcs for YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN

Measure Date Value
2008: YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 0
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 0
Number of employers contributing to the scheme 2008-01-01 0

Measure	Date	Value
2008: YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	0
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	0
Number of employers contributing to the scheme	2008-01-01	0

Form 5500 Responses for YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN

2008: YALE APPLIANCE & LIGHTING, INC. WELFARE BENEFITS PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	Yes
2008-01-01	This submission is the final filing	Yes
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

6177

Policy instance

Insurance contract or identification number	6177
Number of Individuals Covered	106
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $4,970
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,371
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ESI EMPLOYEE ASSISTANCE GROUP (National Association of Insurance Commissioners NAIC id number: 23809 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	127
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $5,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

62938000

Policy instance

Insurance contract or identification number	62938000
Number of Individuals Covered	95
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $31,971
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $818,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,532
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

144411

Policy instance

Insurance contract or identification number	144411
Number of Individuals Covered	104
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $9,730
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,314
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	YALE APPLIANCE AND LIGHTING
Employer identification number (EIN):	042457546
NAIC Classification:	443141
NAIC Description:	Household Appliance Stores