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BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 401k Plan overview

Plan NameBLUESTAR REFRESHMENT SERVICES 401(K) PLAN
Plan identification number 001

BLUESTAR REFRESHMENT SERVICES 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BLUESTAR REFRESHMENT SERVICES has sponsored the creation of one or more 401k plans.

Company Name:BLUESTAR REFRESHMENT SERVICES
Employer identification number (EIN):205196078
NAIC Classification:454390
NAIC Description:Other Direct Selling Establishments

Additional information about BLUESTAR REFRESHMENT SERVICES

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C2883554

More information about BLUESTAR REFRESHMENT SERVICES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUESTAR REFRESHMENT SERVICES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01ANTONETTE BEDAL2023-09-21 ANTONETTE BEDAL2023-09-21
0012022-01-01KEN FEY2023-03-27 KEN FEY2023-03-27
0012021-01-01KEN FEY2022-03-28 KEN FEY2022-03-28
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01ANTONETTE BEDAL ANTONETTE BEDAL2018-10-08
0012017-01-01ANTONETTE BEDAL ANTONETTE BEDAL2018-10-04
0012016-01-01KEN FEY KEN FEY2017-10-11
0012015-01-01ANTONETTE BEDAL2016-04-15 ANTONETTE BEDAL2016-04-15
0012014-01-01ANTONETTE BEDAL2015-09-29 ANTONETTE BEDAL2015-09-29
0012014-01-01KEN FEY2015-09-24 KEN FEY2015-09-24
0012013-02-15KEN FEY2014-07-01 KEN FEY2014-07-01

Plan Statistics for BLUESTAR REFRESHMENT SERVICES 401(K) PLAN

401k plan membership statisitcs for BLUESTAR REFRESHMENT SERVICES 401(K) PLAN

Measure Date Value
2020: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01510
Total number of active participants reported on line 7a of the Form 55002020-01-0126
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0158
Total of all active and inactive participants2020-01-0184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0184
Number of participants with account balances2020-01-0182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0174
2019: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01363
Total number of active participants reported on line 7a of the Form 55002019-01-01332
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-014
Total of all active and inactive participants2019-01-01336
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01336
Number of participants with account balances2019-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-014
2018: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01296
Total number of active participants reported on line 7a of the Form 55002018-01-01286
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-015
Total of all active and inactive participants2018-01-01291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01291
Number of participants with account balances2018-01-0135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-017
2017: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01231
Total number of active participants reported on line 7a of the Form 55002017-01-01241
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-013
Total of all active and inactive participants2017-01-01244
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01244
Number of participants with account balances2017-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-018
2016: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01164
Total number of active participants reported on line 7a of the Form 55002016-01-01190
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 participants2016-01-01190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01190
Number of participants with account balances2016-01-0125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010

Financial Data on BLUESTAR REFRESHMENT SERVICES 401(K) PLAN

Measure Date Value
2020 : BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets2020-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$0
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$35,197
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$40,717
Total income from all sources (including contributions)2020-12-31$193,351
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$238,732
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$197,637
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Value of total corrective distributions2020-12-31$35,197
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$89,605
Value of total assets at end of year2020-12-31$705,066
Value of total assets at beginning of year2020-12-31$755,967
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$5,898
Total income from rents2020-12-31$0
Total interest from all sources2020-12-31$1,862
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$0
Administrative expenses professional fees incurred2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$100,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Amount of non-exempt transactions with any party-in-interest2020-12-31$0
Contributions received from participants2020-12-31$72,800
Participant contributions at end of year2020-12-31$22,477
Participant contributions at beginning of year2020-12-31$28,291
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$833
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$35,197
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$40,717
Other income not declared elsewhere2020-12-31$7,143
Administrative expenses (other) incurred2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-45,381
Value of net assets at end of year (total assets less liabilities)2020-12-31$669,869
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$715,250
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2020-12-31$0
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2020-12-31$0
Investment advisory and management fees2020-12-31$0
Value of interest in pooled separate accounts at end of year2020-12-31$672,428
Value of interest in pooled separate accounts at beginning of year2020-12-31$718,385
Interest on participant loans2020-12-31$1,862
Income. Interest from loans (other than to participants)2020-12-31$0
Interest earned on other investments2020-12-31$0
Income. Interest from US Government securities2020-12-31$0
Income. Interest from corporate debt instruments2020-12-31$0
Value of interest in common/collective trusts at end of year2020-12-31$10,161
Value of interest in common/collective trusts at beginning of year2020-12-31$9,291
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$0
Net investment gain/loss from pooled separate accounts2020-12-31$94,756
Net investment gain or loss from common/collective trusts2020-12-31$-15
Net gain/loss from 103.12 investment entities2020-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$15,972
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$0
Income. Dividends from preferred stock2020-12-31$0
Income. Dividends from common stock2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$197,637
Contract administrator fees2020-12-31$5,898
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$0
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$0
Aggregate carrying amount (costs) on sale of assets2020-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2020-12-31$0
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31ALON SHATZKI
Accountancy firm EIN2020-12-31843211753
2019 : BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets2019-12-31$0
Unrealized appreciation/depreciation of real estate assets2019-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets to this plan2019-12-31$0
Total transfer of assets to this plan2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$40,717
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$40,717
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$36,300
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$36,300
Total income from all sources (including contributions)2019-12-31$313,078
Total income from all sources (including contributions)2019-12-31$313,078
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$103,736
Total of all expenses incurred2019-12-31$103,736
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$57,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$57,306
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Value of total corrective distributions2019-12-31$40,717
Value of total corrective distributions2019-12-31$40,717
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$181,131
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$181,131
Value of total assets at end of year2019-12-31$755,967
Value of total assets at end of year2019-12-31$755,967
Value of total assets at beginning of year2019-12-31$542,208
Value of total assets at beginning of year2019-12-31$542,208
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$5,713
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$5,713
Total income from rents2019-12-31$0
Total income from rents2019-12-31$0
Total interest from all sources2019-12-31$1,138
Total interest from all sources2019-12-31$1,138
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$0
Administrative expenses professional fees incurred2019-12-31$0
Administrative expenses professional fees incurred2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$100,000
Value of fidelity bond cover2019-12-31$100,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Amount of non-exempt transactions with any party-in-interest2019-12-31$0
Amount of non-exempt transactions with any party-in-interest2019-12-31$0
Contributions received from participants2019-12-31$127,139
Contributions received from participants2019-12-31$127,139
Participant contributions at end of year2019-12-31$28,291
Participant contributions at end of year2019-12-31$28,291
Participant contributions at beginning of year2019-12-31$5,831
Participant contributions at beginning of year2019-12-31$5,831
Participant contributions at end of year2019-12-31$0
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$11,723
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$11,723
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$40,717
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$40,717
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$36,300
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$36,300
Other income not declared elsewhere2019-12-31$0
Other income not declared elsewhere2019-12-31$0
Administrative expenses (other) incurred2019-12-31$0
Administrative expenses (other) incurred2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$209,342
Value of net income/loss2019-12-31$209,342
Value of net assets at end of year (total assets less liabilities)2019-12-31$715,250
Value of net assets at end of year (total assets less liabilities)2019-12-31$715,250
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$505,908
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$505,908
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2019-12-31$0
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2019-12-31$0
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2019-12-31$0
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2019-12-31$0
Investment advisory and management fees2019-12-31$0
Investment advisory and management fees2019-12-31$0
Value of interest in pooled separate accounts at end of year2019-12-31$718,385
Value of interest in pooled separate accounts at end of year2019-12-31$718,385
Value of interest in pooled separate accounts at beginning of year2019-12-31$519,177
Value of interest in pooled separate accounts at beginning of year2019-12-31$519,177
Interest on participant loans2019-12-31$1,138
Interest on participant loans2019-12-31$1,138
Income. Interest from loans (other than to participants)2019-12-31$0
Income. Interest from loans (other than to participants)2019-12-31$0
Interest earned on other investments2019-12-31$0
Interest earned on other investments2019-12-31$0
Income. Interest from US Government securities2019-12-31$0
Income. Interest from US Government securities2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
Value of interest in common/collective trusts at end of year2019-12-31$9,291
Value of interest in common/collective trusts at end of year2019-12-31$9,291
Value of interest in common/collective trusts at beginning of year2019-12-31$17,200
Value of interest in common/collective trusts at beginning of year2019-12-31$17,200
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$0
Net investment gain/loss from pooled separate accounts2019-12-31$130,271
Net investment gain/loss from pooled separate accounts2019-12-31$130,271
Net investment gain or loss from common/collective trusts2019-12-31$538
Net investment gain or loss from common/collective trusts2019-12-31$538
Net gain/loss from 103.12 investment entities2019-12-31$0
Net gain/loss from 103.12 investment entities2019-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$42,269
Contributions received in cash from employer2019-12-31$42,269
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Income. Dividends from preferred stock2019-12-31$0
Income. Dividends from preferred stock2019-12-31$0
Income. Dividends from common stock2019-12-31$0
Income. Dividends from common stock2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$57,306
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$57,306
Contract administrator fees2019-12-31$5,713
Contract administrator fees2019-12-31$5,713
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$0
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Aggregate proceeds on sale of assets2019-12-31$0
Aggregate proceeds on sale of assets2019-12-31$0
Aggregate carrying amount (costs) on sale of assets2019-12-31$0
Aggregate carrying amount (costs) on sale of assets2019-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2019-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2019-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31AUDIT AND TAX SOLUTIONS, CPAS INC
Accountancy firm name2019-12-31AUDIT AND TAX SOLUTIONS, CPAS INC
Accountancy firm EIN2019-12-31943211753
Accountancy firm EIN2019-12-31943211753
2018 : BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets2018-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$0
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total transfer of assets to this plan2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$36,300
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$41,798
Total income from all sources (including contributions)2018-12-31$182,074
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$67,667
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$25,216
Expenses. Certain deemed distributions of participant loans2018-12-31$0
Value of total corrective distributions2018-12-31$37,358
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$232,677
Value of total assets at end of year2018-12-31$542,208
Value of total assets at beginning of year2018-12-31$433,299
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$5,093
Total income from rents2018-12-31$0
Total interest from all sources2018-12-31$327
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$0
Administrative expenses professional fees incurred2018-12-31$0
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$50,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Amount of non-exempt transactions with any party-in-interest2018-12-31$0
Contributions received from participants2018-12-31$134,680
Participant contributions at end of year2018-12-31$5,831
Participant contributions at beginning of year2018-12-31$4,741
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$53,965
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$36,300
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$41,798
Other income not declared elsewhere2018-12-31$36
Administrative expenses (other) incurred2018-12-31$0
Liabilities. Value of operating payables at beginning of year2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$114,407
Value of net assets at end of year (total assets less liabilities)2018-12-31$505,908
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$391,501
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2018-12-31$0
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2018-12-31$0
Investment advisory and management fees2018-12-31$0
Value of interest in pooled separate accounts at end of year2018-12-31$519,177
Value of interest in pooled separate accounts at beginning of year2018-12-31$421,807
Interest on participant loans2018-12-31$327
Income. Interest from loans (other than to participants)2018-12-31$0
Interest earned on other investments2018-12-31$0
Income. Interest from US Government securities2018-12-31$0
Income. Interest from corporate debt instruments2018-12-31$0
Value of interest in common/collective trusts at end of year2018-12-31$17,200
Value of interest in common/collective trusts at beginning of year2018-12-31$6,751
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$0
Net investment gain/loss from pooled separate accounts2018-12-31$-50,877
Net investment gain or loss from common/collective trusts2018-12-31$-89
Net gain/loss from 103.12 investment entities2018-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$44,032
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$0
Income. Dividends from preferred stock2018-12-31$0
Income. Dividends from common stock2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$25,216
Contract administrator fees2018-12-31$5,093
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$0
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Aggregate proceeds on sale of assets2018-12-31$0
Aggregate carrying amount (costs) on sale of assets2018-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2018-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31AUDIT AND TAX SOLUTIONS CPAS
Accountancy firm EIN2018-12-31943211753
2017 : BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets2017-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$0
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total transfer of assets to this plan2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$41,798
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$29,002
Total income from all sources (including contributions)2017-12-31$210,258
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$65,113
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$19,062
Expenses. Certain deemed distributions of participant loans2017-12-31$0
Value of total corrective distributions2017-12-31$41,798
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$150,963
Value of total assets at end of year2017-12-31$433,299
Value of total assets at beginning of year2017-12-31$275,358
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$4,253
Total income from rents2017-12-31$0
Total interest from all sources2017-12-31$292
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$0
Administrative expenses professional fees incurred2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$50,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Amount of non-exempt transactions with any party-in-interest2017-12-31$0
Contributions received from participants2017-12-31$114,002
Participant contributions at end of year2017-12-31$4,741
Participant contributions at beginning of year2017-12-31$7,797
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$41,798
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$29,002
Other income not declared elsewhere2017-12-31$0
Administrative expenses (other) incurred2017-12-31$0
Liabilities. Value of operating payables at beginning of year2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$145,145
Value of net assets at end of year (total assets less liabilities)2017-12-31$391,501
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$246,356
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2017-12-31$0
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2017-12-31$0
Investment advisory and management fees2017-12-31$0
Value of interest in pooled separate accounts at end of year2017-12-31$421,807
Value of interest in pooled separate accounts at beginning of year2017-12-31$263,068
Interest on participant loans2017-12-31$292
Income. Interest from loans (other than to participants)2017-12-31$0
Interest earned on other investments2017-12-31$0
Income. Interest from US Government securities2017-12-31$0
Income. Interest from corporate debt instruments2017-12-31$0
Value of interest in common/collective trusts at end of year2017-12-31$6,751
Value of interest in common/collective trusts at beginning of year2017-12-31$4,493
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$0
Net investment gain/loss from pooled separate accounts2017-12-31$58,963
Net investment gain or loss from common/collective trusts2017-12-31$40
Net gain/loss from 103.12 investment entities2017-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31Yes
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$36,961
Employer contributions (assets) at end of year2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$0
Income. Dividends from preferred stock2017-12-31$0
Income. Dividends from common stock2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$19,062
Contract administrator fees2017-12-31$4,253
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$0
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$0
Aggregate carrying amount (costs) on sale of assets2017-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2017-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31BPM LLP
Accountancy firm EIN2017-12-31814234542
2016 : BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets2016-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$0
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets to this plan2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$29,002
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$141,854
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$14,552
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,997
Expenses. Certain deemed distributions of participant loans2016-12-31$0
Value of total corrective distributions2016-12-31$8,616
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$130,096
Value of total assets at end of year2016-12-31$275,358
Value of total assets at beginning of year2016-12-31$119,054
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$2,939
Total income from rents2016-12-31$0
Total interest from all sources2016-12-31$47
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$0
Administrative expenses professional fees incurred2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$10,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Amount of non-exempt transactions with any party-in-interest2016-12-31$0
Contributions received from participants2016-12-31$80,752
Participant contributions at end of year2016-12-31$7,797
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$1,388
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$25,553
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$29,002
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Other income not declared elsewhere2016-12-31$0
Administrative expenses (other) incurred2016-12-31$0
Liabilities. Value of operating payables at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$127,302
Value of net assets at end of year (total assets less liabilities)2016-12-31$246,356
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$119,054
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2016-12-31$0
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2016-12-31$0
Investment advisory and management fees2016-12-31$0
Value of interest in pooled separate accounts at end of year2016-12-31$263,068
Value of interest in pooled separate accounts at beginning of year2016-12-31$113,825
Interest on participant loans2016-12-31$47
Income. Interest from loans (other than to participants)2016-12-31$0
Interest earned on other investments2016-12-31$0
Income. Interest from US Government securities2016-12-31$0
Income. Interest from corporate debt instruments2016-12-31$0
Value of interest in common/collective trusts at end of year2016-12-31$4,493
Value of interest in common/collective trusts at beginning of year2016-12-31$2,454
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$0
Net investment gain/loss from pooled separate accounts2016-12-31$11,682
Net investment gain or loss from common/collective trusts2016-12-31$29
Net gain/loss from 103.12 investment entities2016-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$23,791
Employer contributions (assets) at end of year2016-12-31$0
Employer contributions (assets) at beginning of year2016-12-31$1,387
Income. Dividends from preferred stock2016-12-31$0
Income. Dividends from common stock2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,997
Contract administrator fees2016-12-31$2,939
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$0
Aggregate carrying amount (costs) on sale of assets2016-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2016-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31BPM LLP
Accountancy firm EIN2016-12-31814234542

Form 5500 Responses for BLUESTAR REFRESHMENT SERVICES 401(K) PLAN

2020: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BLUESTAR REFRESHMENT SERVICES 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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 – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number459544
Policy instance 1
Insurance contract or identification number459544
Number of Individuals Covered84
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,280
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,280
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number459544
Policy instance 1
Insurance contract or identification number459544
Number of Individuals Covered336
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,992
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,343
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number459544
Policy instance 1
Insurance contract or identification number459544
Number of Individuals Covered291
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,432
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,432
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number459544
Policy instance 1
Insurance contract or identification number459544
Number of Individuals Covered244
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,589
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,589
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameFARMERS FINANCIAL SOLUTIONS LLC

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