401k Plan data: FORTIS ENERGY SERVICES plan

FORTIS ENERGY SERVICES 401k Plan overview

Plan Name	FORTIS ENERGY SERVICES
Plan identification number	501

FORTIS ENERGY SERVICES Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

FORTIS ENERGY SERVICES has sponsored the creation of one or more 401k plans.

Company Name: FORTIS ENERGY SERVICES

Employer identification number (EIN): 201043926

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Additional information about FORTIS ENERGY SERVICES

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1998-03-31

Company Identification Number: CP13550

Legal Registered Office Address: 125 W CENTRAL PKY
-
CINCINNATI
United States of America (USA)
45202

More information about FORTIS ENERGY SERVICES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FORTIS ENERGY SERVICES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-07-01 MEGHAN MCWILLIAMS 2022-11-30
501 2020-07-01 MEGHAN MCWILLIAMS 2022-01-26
501 2019-07-01 MEGHAN BERG 2021-04-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2021-07-01	MEGHAN MCWILLIAMS	2022-11-30
501	2020-07-01	MEGHAN MCWILLIAMS	2022-01-26
501	2019-07-01	MEGHAN BERG	2021-04-08

Plan Statistics for FORTIS ENERGY SERVICES

401k plan membership statisitcs for FORTIS ENERGY SERVICES

Measure Date Value
2021: FORTIS ENERGY SERVICES 2021 401k membership
Total participants, beginning-of-year 2021-07-01 117
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 92
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 92
Number of employers contributing to the scheme 2021-07-01 0
2020: FORTIS ENERGY SERVICES 2020 401k membership
Total participants, beginning-of-year 2020-07-01 37
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 117
Number of retired or separated participants receiving benefits 2020-07-01 3
Number of other retired or separated participants entitled to future benefits 2020-07-01 48
Total of all active and inactive participants 2020-07-01 168
Number of employers contributing to the scheme 2020-07-01 0
2019: FORTIS ENERGY SERVICES 2019 401k membership
Total participants, beginning-of-year 2019-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 105
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 105
Number of employers contributing to the scheme 2019-07-01 0

Measure	Date	Value
2021: FORTIS ENERGY SERVICES 2021 401k membership
Total participants, beginning-of-year	2021-07-01	117
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	92
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	92
Number of employers contributing to the scheme	2021-07-01	0
2020: FORTIS ENERGY SERVICES 2020 401k membership
Total participants, beginning-of-year	2020-07-01	37
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	117
Number of retired or separated participants receiving benefits	2020-07-01	3
Number of other retired or separated participants entitled to future benefits	2020-07-01	48
Total of all active and inactive participants	2020-07-01	168
Number of employers contributing to the scheme	2020-07-01	0
2019: FORTIS ENERGY SERVICES 2019 401k membership
Total participants, beginning-of-year	2019-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	105
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	105
Number of employers contributing to the scheme	2019-07-01	0

Form 5500 Responses for FORTIS ENERGY SERVICES

2021: FORTIS ENERGY SERVICES 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: FORTIS ENERGY SERVICES 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: FORTIS ENERGY SERVICES 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	First time form 5500 has been submitted	Yes
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BD4L

Policy instance

Insurance contract or identification number	GLUG0BD4L
Number of Individuals Covered	92
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $6,840
Total amount of fees paid to insurance company	USD $3,734
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $45,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,840
Amount paid for insurance broker fees	3734
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30041270

Policy instance

Insurance contract or identification number	30041270
Number of Individuals Covered	67
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $772
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $772
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

2592

Policy instance

Insurance contract or identification number	2592
Number of Individuals Covered	176
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $4,029
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,029
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

405207

Policy instance

Insurance contract or identification number	405207
Number of Individuals Covered	172
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $71,553
Total amount of fees paid to insurance company	USD $580
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,384
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BD4L

Policy instance

Insurance contract or identification number	GLUG0BD4L
Number of Individuals Covered	99
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $5,242
Total amount of fees paid to insurance company	USD $2,364
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $34,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,242
Amount paid for insurance broker fees	2364
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30041270

Policy instance

Insurance contract or identification number	30041270
Number of Individuals Covered	88
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $622
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $622
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

2592

Policy instance

Insurance contract or identification number	2592
Number of Individuals Covered	229
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
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 $0
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
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

405207

Policy instance

Insurance contract or identification number	405207
Number of Individuals Covered	241
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $29,695
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,695
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BD4L

Policy instance

Insurance contract or identification number	GLUG0BD4L
Number of Individuals Covered	38
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $9,658
Total amount of fees paid to insurance company	USD $3,181
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $64,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,305
Amount paid for insurance broker fees	3181
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30041270

Policy instance

Insurance contract or identification number	30041270
Number of Individuals Covered	105
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $864
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $864
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

2592

Policy instance

Insurance contract or identification number	2592
Number of Individuals Covered	89
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $3,884
Total amount of fees paid to insurance company	USD $214
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,884
Amount paid for insurance broker fees	214
Additional information about fees paid to insurance broker	NEW BUSINESS BONUS RETENTION BONUS
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

405207

Policy instance

Insurance contract or identification number	405207
Number of Individuals Covered	88
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $29,116
Total amount of fees paid to insurance company	USD $45
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,116
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS

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Company Name:	FORTIS ENERGY SERVICES
Employer identification number (EIN):	201043926
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1998-03-31
Company Identification Number:	CP13550
Legal Registered Office Address:	125 W CENTRAL PKY - CINCINNATI United States of America (USA) 45202