401k Plan data: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN plan

PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN
Plan identification number	501

PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Supplemental unemployment Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

PEGASUS RESIDENTIAL LLC has sponsored the creation of one or more 401k plans.

Company Name: PEGASUS RESIDENTIAL LLC

Employer identification number (EIN): 263972108

NAIC Classification: 531310

Additional information about PEGASUS RESIDENTIAL LLC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 1409157

More information about PEGASUS RESIDENTIAL LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-02-01 LANDON BRIDGERS LANDON BRIDGERS 2017-06-22
501 2015-02-01 CHRISTOPHER LAWRENCE CHRISTOPHER LAWRENCE 2016-06-14
501 2014-02-01 CHRISTOPHER LAWRENCE CHRISTOPHER LAWRENCE 2015-06-30

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-02-01	LANDON BRIDGERS	LANDON BRIDGERS	2017-06-22
501	2015-02-01	CHRISTOPHER LAWRENCE	CHRISTOPHER LAWRENCE	2016-06-14
501	2014-02-01	CHRISTOPHER LAWRENCE	CHRISTOPHER LAWRENCE	2015-06-30

Plan Statistics for PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN

401k plan membership statisitcs for PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN

Measure Date Value
2016: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-02-01 610
Total number of active participants reported on line 7a of the Form 5500 2016-02-01 650
Total of all active and inactive participants 2016-02-01 650
Total participants 2016-02-01 650
2015: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-02-01 475
Total number of active participants reported on line 7a of the Form 5500 2015-02-01 610
Total of all active and inactive participants 2015-02-01 610
Total participants 2015-02-01 610
2014: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-02-01 399
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 475
Total of all active and inactive participants 2014-02-01 475
Total participants 2014-02-01 475

Measure	Date	Value
2016: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-02-01	610
Total number of active participants reported on line 7a of the Form 5500	2016-02-01	650
Total of all active and inactive participants	2016-02-01	650
Total participants	2016-02-01	650
2015: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-02-01	475
Total number of active participants reported on line 7a of the Form 5500	2015-02-01	610
Total of all active and inactive participants	2015-02-01	610
Total participants	2015-02-01	610
2014: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-02-01	399
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	475
Total of all active and inactive participants	2014-02-01	475
Total participants	2014-02-01	475

Form 5500 Responses for PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN

2016: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	First time form 5500 has been submitted	Yes
2016-02-01	Submission has been amended	No
2016-02-01	This submission is the final filing	No
2016-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-02-01	Plan is a collectively bargained plan	No
2016-02-01	Plan funding arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes
2015: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	First time form 5500 has been submitted	Yes
2015-02-01	Submission has been amended	No
2015-02-01	This submission is the final filing	No
2015-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-02-01	Plan is a collectively bargained plan	No
2015-02-01	Plan funding arrangement – Insurance	Yes
2015-02-01	Plan benefit arrangement – Insurance	Yes
2014: PEGASUS RESIDENTIAL WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	First time form 5500 has been submitted	Yes
2014-02-01	Submission has been amended	No
2014-02-01	This submission is the final filing	No
2014-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-02-01	Plan is a collectively bargained plan	No
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA7016

Policy instance

Insurance contract or identification number	GA7016
Number of Individuals Covered	610
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $125,276
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $2,895,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $125,276
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RESOURCE ALLIANCE LLC

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

955826

Policy instance

Insurance contract or identification number	955826
Number of Individuals Covered	441
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $8,137
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $162,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,137
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RESOURCE ALLIANCE LLC

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

GA2749

Policy instance

Insurance contract or identification number	GA2749
Number of Individuals Covered	582
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $16,781
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 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
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 Carrier	USD $158,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,781
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RESOURCE ALLIANCE LLC

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA7016

Policy instance

Insurance contract or identification number	GA7016
Number of Individuals Covered	475
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $107,790
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $2,210,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,790
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RESOURCE ALLIANCE LLC

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

Policy contract number

02338

Policy instance

Insurance contract or identification number	02338
Number of Individuals Covered	475
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $13,914
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $92,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,914
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RESOURCE ALLIANCE LLC

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Company Name:	PEGASUS RESIDENTIAL LLC
Employer identification number (EIN):	263972108
NAIC Classification:	531310

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	1409157