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SHALOM INTERNATIONAL CORP. MEDICAL PLAN 401k Plan overview

Plan NameSHALOM INTERNATIONAL CORP. MEDICAL PLAN
Plan identification number 501

SHALOM INTERNATIONAL CORP. MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

SHALOM INTERNATIONAL CORP. has sponsored the creation of one or more 401k plans.

Company Name:SHALOM INTERNATIONAL CORP.
Employer identification number (EIN):222438649
NAIC Classification:423990
NAIC Description:Other Miscellaneous Durable Goods Merchant Wholesalers

Additional information about SHALOM INTERNATIONAL CORP.

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 2005-04-19
Company Identification Number: 20051135074
Legal Registered Office Address: 502 NORTH DIVISION STREET

CARSON CITY
United States of America (USA)
89703

More information about SHALOM INTERNATIONAL CORP.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHALOM INTERNATIONAL CORP. MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-02-01ANGELO FUSARO
5012015-02-01ANGELO FUSARO
5012014-02-01EDWARD SHOUEL
5012013-02-01EDWARD SHOUEL
5012012-02-01EDWARD SHOUEL
5012011-02-01EDWARD SHOUEL
5012009-02-01EDWARD SHOUEL
5012009-02-01 EDWARD SHOUEL2010-07-13

Plan Statistics for SHALOM INTERNATIONAL CORP. MEDICAL PLAN

401k plan membership statisitcs for SHALOM INTERNATIONAL CORP. MEDICAL PLAN

Measure Date Value
2016: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01126
Total number of active participants reported on line 7a of the Form 55002016-02-01120
Total of all active and inactive participants2016-02-01120
Total participants2016-02-01120
2015: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01126
Total number of active participants reported on line 7a of the Form 55002015-02-01126
Total of all active and inactive participants2015-02-01126
Total participants2015-02-01126
2014: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01127
Total number of active participants reported on line 7a of the Form 55002014-02-01126
Total of all active and inactive participants2014-02-01126
Total participants2014-02-01126
2013: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01123
Total number of active participants reported on line 7a of the Form 55002013-02-01127
Total of all active and inactive participants2013-02-01127
Total participants2013-02-01127
2012: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01164
Total number of active participants reported on line 7a of the Form 55002012-02-01123
Total of all active and inactive participants2012-02-01123
Total participants2012-02-01123
2011: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-0176
Total number of active participants reported on line 7a of the Form 55002011-02-0187
Total of all active and inactive participants2011-02-0187
Total participants2011-02-0187
2009: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-0178
Total number of active participants reported on line 7a of the Form 55002009-02-0175
Number of retired or separated participants receiving benefits2009-02-010
Number of other retired or separated participants entitled to future benefits2009-02-010
Total of all active and inactive participants2009-02-0175

Form 5500 Responses for SHALOM INTERNATIONAL CORP. MEDICAL PLAN

2016: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Submission has been amendedNo
2014-02-01This submission is the final filingNo
2014-02-01This return/report is a short plan year return/report (less than 12 months)No
2014-02-01Plan is a collectively bargained planNo
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Submission has been amendedNo
2013-02-01This submission is the final filingNo
2013-02-01This return/report is a short plan year return/report (less than 12 months)No
2013-02-01Plan is a collectively bargained planNo
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Submission has been amendedNo
2012-02-01This submission is the final filingNo
2012-02-01This return/report is a short plan year return/report (less than 12 months)No
2012-02-01Plan is a collectively bargained planNo
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Submission has been amendedNo
2011-02-01This submission is the final filingNo
2011-02-01This return/report is a short plan year return/report (less than 12 months)No
2011-02-01Plan is a collectively bargained planNo
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2009: SHALOM INTERNATIONAL CORP. MEDICAL PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Submission has been amendedNo
2009-02-01This submission is the final filingNo
2009-02-01This return/report is a short plan year return/report (less than 12 months)No
2009-02-01Plan is a collectively bargained planNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSI25209
Policy instance 1
Insurance contract or identification numberSI25209
Number of Individuals Covered156
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $54,880
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 $1,383,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,880
Insurance broker organization code?3
Insurance broker nameMIDDLEGATE INSURANCE AGENCY
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSI25209
Policy instance 1
Insurance contract or identification numberSI25209
Number of Individuals Covered164
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $54,104
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 $1,352,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,104
Insurance broker organization code?3
Insurance broker nameMIDDLEGATE INSURANCE AGENCY
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSI25209
Policy instance 1
Insurance contract or identification numberSI25209
Number of Individuals Covered172
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $48,608
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 $1,215,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,608
Insurance broker organization code?3
Insurance broker nameMIDDLEGATE INSURANCE AGENCY
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSI25209
Policy instance 1
Insurance contract or identification numberSI25209
Number of Individuals Covered164
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $38,533
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $944,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,533
Insurance broker organization code?3
Insurance broker nameMIDDLEGATE INSURANCE AGENCY
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSI25209
Policy instance 1
Insurance contract or identification numberSI25209
Number of Individuals Covered154
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $34,386
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $878,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number00429P
Policy instance 1
Insurance contract or identification number00429P
Number of Individuals Covered7
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,231
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 $30,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,231
Insurance broker organization code?3
Insurance broker nameMIDDLEGATE INSURANCE AGENCY
HEALTH NET LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number036110
Policy instance 2
Insurance contract or identification number036110
Number of Individuals Covered130
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $26,043
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 $651,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,043
Insurance broker organization code?3
Insurance broker nameMIDDLEGATE INSURANCE AGENCY

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