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INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 401k Plan overview

Plan NameINDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN
Plan identification number 501

INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

INDUSTRIAL STAFFING SERVICES, INC has sponsored the creation of one or more 401k plans.

Company Name:INDUSTRIAL STAFFING SERVICES, INC
Employer identification number (EIN):200499856
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Additional information about INDUSTRIAL STAFFING SERVICES, INC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 2001-01-30
Company Identification Number: 602097799
Legal Registered Office Address: 2401 56TH ST SW

EVERETT
United States of America (USA)
98203

More information about INDUSTRIAL STAFFING SERVICES, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012016-01-01LINDA BLOCK
5012015-01-01LINDA BLOCK

Plan Statistics for INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN

401k plan membership statisitcs for INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN

Measure Date Value
2022: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01663
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-010
2021: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-010
Total number of active participants reported on line 7a of the Form 55002021-01-01663
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01663
2016: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01193
Total number of active participants reported on line 7a of the Form 55002016-01-01136
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01136
2015: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01159
Total number of active participants reported on line 7a of the Form 55002015-01-0188
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010

Financial Data on INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN

Measure Date Value
2021 : INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2021 401k financial data
Total income from all sources2021-12-31$0
Total plan assets at end of year2021-12-31$0
Total plan assets at beginning of year2021-12-31$0
Net plan assets at end of year (total assets less liabilities)2021-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$0

Form 5500 Responses for INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN

2022: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01This submission is the final filingYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2016: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: INDUSTRIAL STAFFING EMPLOYEE MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 1
Number of Individuals Covered161
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,076
Total amount of fees paid to insurance companyUSD $262,958
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees120336
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $6,076
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 2
Number of Individuals Covered738
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $222,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 3
Number of Individuals Covered738
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $50,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 1
Number of Individuals Covered142
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $11,208
Total amount of fees paid to insurance companyUSD $216,957
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $64,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,804
Amount paid for insurance broker fees100278
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 2
Number of Individuals Covered581
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $7,279
Welfare Benefit Premiums Paid to CarrierUSD $185,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,279
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberMFQ01039
Policy instance 1
Insurance contract or identification numberMFQ01039
Number of Individuals Covered45
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,820
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
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 $56,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,820
Insurance broker organization code?3
Insurance broker nameASSURANCE AGENCY, LTD
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberMFQ01039
Policy instance 2
Insurance contract or identification numberMFQ01039
Number of Individuals Covered88
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
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 $4,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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