401k Plan data: TANTILLO GROUP WELFARE PLAN plan

TANTILLO GROUP WELFARE PLAN 401k Plan overview

Plan Name	TANTILLO GROUP WELFARE PLAN
Plan identification number	501

TANTILLO GROUP WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

NISSAN 112 SALES CORP. has sponsored the creation of one or more 401k plans.

Company Name: NISSAN 112 SALES CORP.

Employer identification number (EIN): 112668987

NAIC Classification: 441110
NAIC Description: New Car Dealers

Additional information about NISSAN 112 SALES CORP.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1983-12-08

Company Identification Number: 876175

Legal Registered Office Address: 730 ROUTE 112
Suffolk
PATCHOGUE
United States of America (USA)
11772

More information about NISSAN 112 SALES CORP.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TANTILLO GROUP WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01 RAYMOND TANTILLO 2020-07-15 RAYMOND TANTILLO 2020-07-15
501 2018-01-01 RAYMOND TANTILLO 2019-09-26 RAYMOND TANTILLO 2019-09-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01	RAYMOND TANTILLO	2020-07-15	RAYMOND TANTILLO	2020-07-15
501	2018-01-01	RAYMOND TANTILLO	2019-09-26	RAYMOND TANTILLO	2019-09-26

Plan Statistics for TANTILLO GROUP WELFARE PLAN

401k plan membership statisitcs for TANTILLO GROUP WELFARE PLAN

Measure Date Value
2022: TANTILLO GROUP WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 156
Total of all active and inactive participants 2022-01-01 156
2021: TANTILLO GROUP WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 140
Total of all active and inactive participants 2021-01-01 140
2020: TANTILLO GROUP WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 280
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 104
Total of all active and inactive participants 2020-01-01 104
2019: TANTILLO GROUP WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 253
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 280
Total of all active and inactive participants 2019-01-01 280
2018: TANTILLO GROUP WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 253
Total of all active and inactive participants 2018-01-01 253

Measure	Date	Value
2022: TANTILLO GROUP WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	156
Total of all active and inactive participants	2022-01-01	156
2021: TANTILLO GROUP WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	140
Total of all active and inactive participants	2021-01-01	140
2020: TANTILLO GROUP WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	280
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	104
Total of all active and inactive participants	2020-01-01	104
2019: TANTILLO GROUP WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	280
Total of all active and inactive participants	2019-01-01	280
2018: TANTILLO GROUP WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	253
Total of all active and inactive participants	2018-01-01	253

Form 5500 Responses for TANTILLO GROUP WELFARE PLAN

2022: TANTILLO GROUP WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: TANTILLO GROUP WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: TANTILLO GROUP WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: TANTILLO GROUP WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: TANTILLO GROUP WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1144018

Policy instance

Insurance contract or identification number	1144018
Number of Individuals Covered	36
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $796
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $796
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00449W

Policy instance

Insurance contract or identification number	N2CK00449W
Number of Individuals Covered	24
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,443
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,443

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00407W

Policy instance

Insurance contract or identification number	N2CK00407W
Number of Individuals Covered	24
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,614
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,614

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00406W

Policy instance

Insurance contract or identification number	N2CK00406W
Number of Individuals Covered	29
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,592
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,592
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00404W

Policy instance

Insurance contract or identification number	N2CK00404W
Number of Individuals Covered	43
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,171
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,171
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00404W

Policy instance

Insurance contract or identification number	N2CK00404W
Number of Individuals Covered	40
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,657
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,657
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00406W

Policy instance

Insurance contract or identification number	N2CK00406W
Number of Individuals Covered	29
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,125
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,125
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00407W

Policy instance

Insurance contract or identification number	N2CK00407W
Number of Individuals Covered	18
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,237
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,237

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00444W

Policy instance

Insurance contract or identification number	N2CK00444W
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $150
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $150

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00449W

Policy instance

Insurance contract or identification number	N2CK00449W
Number of Individuals Covered	20
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $628
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $628

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1144018

Policy instance

Insurance contract or identification number	1144018
Number of Individuals Covered	33
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,200
Total amount of fees paid to insurance company	USD $182
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,200
Insurance broker organization code?	3
Amount paid for insurance broker fees	182

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00449W

Policy instance

Insurance contract or identification number	N2CK00449W
Number of Individuals Covered	17
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $871
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $871

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00444W

Policy instance

Insurance contract or identification number	N2CK00444W
Number of Individuals Covered	5
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $545
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $545

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00407W

Policy instance

Insurance contract or identification number	N2CK00407W
Number of Individuals Covered	20
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,368
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,368

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00406W

Policy instance

Insurance contract or identification number	N2CK00406W
Number of Individuals Covered	24
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,550
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,550
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00404W

Policy instance

Insurance contract or identification number	N2CK00404W
Number of Individuals Covered	38
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,480
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,480
Insurance broker organization code?	3

HEALTHNOW NEW YORK INC. (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

52-9658-2275

Policy instance

Insurance contract or identification number	52-9658-2275
Number of Individuals Covered	135
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $55,164
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,838,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,164
Insurance broker organization code?	3

EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )

Policy contract number

Policy instance

Number of Individuals Covered	145
Insurance policy start date	2019-07-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $39,819
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $995,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,819
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00449W

Policy instance

Insurance contract or identification number	N2CK00449W
Number of Individuals Covered	14
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $634
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $634
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00404W

Policy instance

Insurance contract or identification number	N2CK00404W
Number of Individuals Covered	36
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,470
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,470
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00407W

Policy instance

Insurance contract or identification number	N2CK00407W
Number of Individuals Covered	21
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,718
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,718
Insurance broker organization code?	3

EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )

Policy contract number

Policy instance

Number of Individuals Covered	142
Insurance policy start date	2018-01-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $31,286
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,196,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,286
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00406W

Policy instance

Insurance contract or identification number	N2CK00406W
Number of Individuals Covered	32
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,861
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,861
Insurance broker organization code?	3

HEALTHPLEX INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11172 )

Policy contract number

N2CK00444W

Policy instance

Insurance contract or identification number	N2CK00444W
Number of Individuals Covered	8
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $503
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $503
Insurance broker organization code?	3

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Company Name:	NISSAN 112 SALES CORP.
Employer identification number (EIN):	112668987
NAIC Classification:	441110
NAIC Description:	New Car Dealers

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1983-12-08
Company Identification Number:	876175
Legal Registered Office Address:	730 ROUTE 112 Suffolk PATCHOGUE United States of America (USA) 11772