401k Plan data: ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN plan

ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	505

ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover

401k Sponsoring company profile

ANN & HOPE, INC. has sponsored the creation of one or more 401k plans.

Company Name: ANN & HOPE, INC.

Employer identification number (EIN): 050272463

NAIC Classification: 452200

Additional information about ANN & HOPE, INC.

Jurisdiction of Incorporation: Secretary of State Rhode Island

Incorporation Date: 1954-08-26

Company Identification Number: 000001078

Legal Registered Office Address: 68 KENNEDY PLAZA, SUITE 3

PROVIDENCE
United States of America (USA)
02903

More information about ANN & HOPE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2019-03-01

Plan Statistics for ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2019: ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-03-01 149
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 139
Total of all active and inactive participants 2019-03-01 139

Measure	Date	Value
2019: ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-03-01	149
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	139
Total of all active and inactive participants	2019-03-01	139

Form 5500 Responses for ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN

2019: ANN & HOPE, INC. HEALTH AND WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	First time form 5500 has been submitted	Yes
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )

Policy contract number

5960 1

Policy instance

Insurance contract or identification number	5960 1
Number of Individuals Covered	39
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $568
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $568
Insurance broker organization code?	3

DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )

Policy contract number

5960 200

Policy instance

Insurance contract or identification number	5960 200
Number of Individuals Covered	104
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $2,228
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,228
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB008078

Policy instance

Insurance contract or identification number	ETB008078
Number of Individuals Covered	139
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $151
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,006
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $151
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0914015

Policy instance

Insurance contract or identification number	0914015
Number of Individuals Covered	166
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $2,534
Total amount of fees paid to insurance company	USD $25,660
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $778,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,534
Amount paid for insurance broker fees	25660
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00511812

Policy instance

Insurance contract or identification number	00511812
Number of Individuals Covered	139
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $1,998
Total amount of fees paid to insurance company	USD $1,345
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,998
Amount paid for insurance broker fees	1345
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	ANN & HOPE, INC.
Employer identification number (EIN):	050272463
NAIC Classification:	452200

Jurisdiction of Incorporation:	Secretary of State Rhode Island
Incorporation Date:	1954-08-26
Company Identification Number:	000001078
Legal Registered Office Address:	68 KENNEDY PLAZA, SUITE 3 PROVIDENCE United States of America (USA) 02903