401k Plan data: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN plan

CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 401k Plan overview

Plan Name	CHESMAR HOMES LTD. HEALTH INSURANCE PLAN
Plan identification number	501

CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 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)

401k Sponsoring company profile

CHESMAR HOMES LTD. has sponsored the creation of one or more 401k plans.

Company Name: CHESMAR HOMES LTD.

Employer identification number (EIN): 202720694

NAIC Classification: 236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHESMAR HOMES LTD. HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-08-01 JEANNE TOTH 2021-06-07
501 2019-08-01 JEANNE TOTH 2021-06-07
501 2018-08-01 JEANNE TOTH 2020-03-24
501 2017-08-01
501 2016-08-01
501 2015-08-01 TERRY SHAKARISAZ TERRY SHAKARISAZ 2017-07-06
501 2014-08-01 TERRY SHAKARISAZ TERRY SHAKARISAZ 2017-07-06
501 2013-08-01 TERRY SHAKARISAZ TERRY SHAKARISAZ 2017-07-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-08-01	JEANNE TOTH	2021-06-07
501	2019-08-01	JEANNE TOTH	2021-06-07
501	2018-08-01	JEANNE TOTH	2020-03-24
501	2017-08-01
501	2016-08-01
501	2015-08-01	TERRY SHAKARISAZ		TERRY SHAKARISAZ	2017-07-06
501	2014-08-01	TERRY SHAKARISAZ		TERRY SHAKARISAZ	2017-07-06
501	2013-08-01	TERRY SHAKARISAZ		TERRY SHAKARISAZ	2017-07-06

Plan Statistics for CHESMAR HOMES LTD. HEALTH INSURANCE PLAN

401k plan membership statisitcs for CHESMAR HOMES LTD. HEALTH INSURANCE PLAN

Measure Date Value
2020: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-08-01 254
Total number of active participants reported on line 7a of the Form 5500 2020-08-01 298
Number of retired or separated participants receiving benefits 2020-08-01 0
Number of other retired or separated participants entitled to future benefits 2020-08-01 0
Total of all active and inactive participants 2020-08-01 298
Number of employers contributing to the scheme 2020-08-01 0
2019: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-08-01 223
Total number of active participants reported on line 7a of the Form 5500 2019-08-01 254
Number of retired or separated participants receiving benefits 2019-08-01 0
Number of other retired or separated participants entitled to future benefits 2019-08-01 0
Total of all active and inactive participants 2019-08-01 254
Number of employers contributing to the scheme 2019-08-01 0
2018: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-08-01 234
Total number of active participants reported on line 7a of the Form 5500 2018-08-01 233
Number of retired or separated participants receiving benefits 2018-08-01 0
Number of other retired or separated participants entitled to future benefits 2018-08-01 0
Total of all active and inactive participants 2018-08-01 233
Number of employers contributing to the scheme 2018-08-01 0
2017: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-08-01 209
Total number of active participants reported on line 7a of the Form 5500 2017-08-01 233
Number of retired or separated participants receiving benefits 2017-08-01 1
Number of other retired or separated participants entitled to future benefits 2017-08-01 0
Total of all active and inactive participants 2017-08-01 234
Number of employers contributing to the scheme 2017-08-01 0
2016: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-08-01 183
Total number of active participants reported on line 7a of the Form 5500 2016-08-01 203
Number of retired or separated participants receiving benefits 2016-08-01 0
Number of other retired or separated participants entitled to future benefits 2016-08-01 0
Total of all active and inactive participants 2016-08-01 203
2015: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-08-01 338
Total number of active participants reported on line 7a of the Form 5500 2015-08-01 384
Total of all active and inactive participants 2015-08-01 384
Total participants 2015-08-01 384
2014: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-08-01 286
Total number of active participants reported on line 7a of the Form 5500 2014-08-01 338
Total of all active and inactive participants 2014-08-01 338
Total participants 2014-08-01 338
2013: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-08-01 221
Total number of active participants reported on line 7a of the Form 5500 2013-08-01 283
Total of all active and inactive participants 2013-08-01 283
Total participants 2013-08-01 283

Measure	Date	Value
2020: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-08-01	254
Total number of active participants reported on line 7a of the Form 5500	2020-08-01	298
Number of retired or separated participants receiving benefits	2020-08-01	0
Number of other retired or separated participants entitled to future benefits	2020-08-01	0
Total of all active and inactive participants	2020-08-01	298
Number of employers contributing to the scheme	2020-08-01	0
2019: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-08-01	223
Total number of active participants reported on line 7a of the Form 5500	2019-08-01	254
Number of retired or separated participants receiving benefits	2019-08-01	0
Number of other retired or separated participants entitled to future benefits	2019-08-01	0
Total of all active and inactive participants	2019-08-01	254
Number of employers contributing to the scheme	2019-08-01	0
2018: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-08-01	234
Total number of active participants reported on line 7a of the Form 5500	2018-08-01	233
Number of retired or separated participants receiving benefits	2018-08-01	0
Number of other retired or separated participants entitled to future benefits	2018-08-01	0
Total of all active and inactive participants	2018-08-01	233
Number of employers contributing to the scheme	2018-08-01	0
2017: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-08-01	209
Total number of active participants reported on line 7a of the Form 5500	2017-08-01	233
Number of retired or separated participants receiving benefits	2017-08-01	1
Number of other retired or separated participants entitled to future benefits	2017-08-01	0
Total of all active and inactive participants	2017-08-01	234
Number of employers contributing to the scheme	2017-08-01	0
2016: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-08-01	183
Total number of active participants reported on line 7a of the Form 5500	2016-08-01	203
Number of retired or separated participants receiving benefits	2016-08-01	0
Number of other retired or separated participants entitled to future benefits	2016-08-01	0
Total of all active and inactive participants	2016-08-01	203
2015: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-08-01	338
Total number of active participants reported on line 7a of the Form 5500	2015-08-01	384
Total of all active and inactive participants	2015-08-01	384
Total participants	2015-08-01	384
2014: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-08-01	286
Total number of active participants reported on line 7a of the Form 5500	2014-08-01	338
Total of all active and inactive participants	2014-08-01	338
Total participants	2014-08-01	338
2013: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-08-01	221
Total number of active participants reported on line 7a of the Form 5500	2013-08-01	283
Total of all active and inactive participants	2013-08-01	283
Total participants	2013-08-01	283

Form 5500 Responses for CHESMAR HOMES LTD. HEALTH INSURANCE PLAN

2020: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2020 form 5500 responses
2020-08-01	Type of plan entity	Single employer plan
2020-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-08-01	Plan funding arrangement – Insurance	Yes
2020-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-08-01	Plan benefit arrangement – Insurance	Yes
2020-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2019 form 5500 responses
2019-08-01	Type of plan entity	Single employer plan
2019-08-01	Plan funding arrangement – Insurance	Yes
2019-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-08-01	Plan benefit arrangement – Insurance	Yes
2019-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-08-01	Type of plan entity	Single employer plan
2018-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-08-01	Type of plan entity	Single employer plan
2017-08-01	Plan funding arrangement – Insurance	Yes
2017-08-01	Plan benefit arrangement – Insurance	Yes
2016: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-08-01	Type of plan entity	Single employer plan
2016-08-01	Submission has been amended	No
2016-08-01	This submission is the final filing	No
2016-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-08-01	Plan is a collectively bargained plan	No
2016-08-01	Plan funding arrangement – Insurance	Yes
2016-08-01	Plan benefit arrangement – Insurance	Yes
2015: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-08-01	Type of plan entity	Single employer plan
2015-08-01	First time form 5500 has been submitted	Yes
2015-08-01	Submission has been amended	No
2015-08-01	This submission is the final filing	No
2015-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-08-01	Plan is a collectively bargained plan	No
2015-08-01	Plan funding arrangement – Insurance	Yes
2015-08-01	Plan benefit arrangement – Insurance	Yes
2014: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-08-01	Type of plan entity	Single employer plan
2014-08-01	First time form 5500 has been submitted	Yes
2014-08-01	Submission has been amended	No
2014-08-01	This submission is the final filing	No
2014-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-08-01	Plan is a collectively bargained plan	No
2014-08-01	Plan funding arrangement – Insurance	Yes
2014-08-01	Plan benefit arrangement – Insurance	Yes
2013: CHESMAR HOMES LTD. HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-08-01	Type of plan entity	Single employer plan
2013-08-01	First time form 5500 has been submitted	Yes
2013-08-01	Submission has been amended	No
2013-08-01	This submission is the final filing	No
2013-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-08-01	Plan is a collectively bargained plan	No
2013-08-01	Plan funding arrangement – Insurance	Yes
2013-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52414 )

Policy contract number

5007/5008

Policy instance

Insurance contract or identification number	5007/5008
Number of Individuals Covered	254
Insurance policy start date	2019-11-01
Insurance policy end date	2020-10-31
Total amount of commissions paid to insurance broker	USD $17,658
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $176,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,658
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

GLUG0BM34

Policy instance

Insurance contract or identification number	GLUG0BM34
Number of Individuals Covered	298
Insurance policy start date	2019-11-01
Insurance policy end date	2020-10-31
Total amount of commissions paid to insurance broker	USD $8,081
Total amount of fees paid to insurance company	USD $740
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 $178,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,081
Amount paid for insurance broker fees	740
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D035513

Policy instance

Insurance contract or identification number	1D035513
Number of Individuals Covered	251
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $13,216
Total amount of fees paid to insurance company	USD $12,757
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $292,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,216
Amount paid for insurance broker fees	12757
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

119074

Policy instance

Insurance contract or identification number	119074
Number of Individuals Covered	431
Insurance policy start date	2017-08-01
Insurance policy end date	2017-10-31
Total amount of commissions paid to insurance broker	USD $27,008
Total amount of fees paid to insurance company	USD $3,458
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $496,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

Potentially related plans

CHESMAR HOMES, LLC 401(K) PLAN [EIN = 202702193]

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Company Name:	CHESMAR HOMES LTD.
Employer identification number (EIN):	202720694
NAIC Classification:	236110