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EMERALD HEALTHCARE, LLC 401(K) PLAN 401k Plan overview

Plan NameEMERALD HEALTHCARE, LLC 401(K) PLAN
Plan identification number 001

EMERALD HEALTHCARE, LLC 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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.
  • 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

EMERALD HEALTHCARE, LLC has sponsored the creation of one or more 401k plans.

Company Name:EMERALD HEALTHCARE, LLC
Employer identification number (EIN):300961801
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about EMERALD HEALTHCARE, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2017-05-30
Company Identification Number: L17000116640
Legal Registered Office Address: 1201 HAYS STREET

TALLAHASSEE

32301

More information about EMERALD HEALTHCARE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMERALD HEALTHCARE, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-04-01YEHUDA RAINDEL

Plan Statistics for EMERALD HEALTHCARE, LLC 401(K) PLAN

401k plan membership statisitcs for EMERALD HEALTHCARE, LLC 401(K) PLAN

Measure Date Value
2022: EMERALD HEALTHCARE, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,072
Total number of active participants reported on line 7a of the Form 55002022-01-011,636
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-011
Total of all active and inactive participants2022-01-011,637
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-011,637
Number of participants with account balances2022-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: EMERALD HEALTHCARE, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,051
Total number of active participants reported on line 7a of the Form 55002021-01-011,071
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-011
Total of all active and inactive participants2021-01-011,072
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-011,072
Number of participants with account balances2021-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: EMERALD HEALTHCARE, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,059
Total number of active participants reported on line 7a of the Form 55002020-01-011,048
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-013
Total of all active and inactive participants2020-01-011,051
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-011,051
Number of participants with account balances2020-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: EMERALD HEALTHCARE, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01385
Total number of active participants reported on line 7a of the Form 55002019-01-011,054
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-015
Total of all active and inactive participants2019-01-011,059
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-011,059
Number of participants with account balances2019-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: EMERALD HEALTHCARE, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01435
Total number of active participants reported on line 7a of the Form 55002018-01-01385
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01385
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01385
Number of participants with account balances2018-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: EMERALD HEALTHCARE, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01439
Total number of active participants reported on line 7a of the Form 55002017-04-01435
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01435
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-04-010
Total participants2017-04-01435
Number of participants with account balances2017-04-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-04-010

Financial Data on EMERALD HEALTHCARE, LLC 401(K) PLAN

Measure Date Value
2022 : EMERALD HEALTHCARE, LLC 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$2,387
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$200,145
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$73,125
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$19,651
Expenses. Certain deemed distributions of participant loans2022-12-31$312
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$417,908
Value of total assets at end of year2022-12-31$1,353,249
Value of total assets at beginning of year2022-12-31$1,223,842
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$53,162
Total interest from all sources2022-12-31$1,778
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$823
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$823
Administrative expenses professional fees incurred2022-12-31$38,652
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$160,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$268,150
Participant contributions at end of year2022-12-31$9,913
Participant contributions at beginning of year2022-12-31$12,802
Participant contributions at end of year2022-12-31$4,211
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$44,403
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$2,387
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$5
Liabilities. Value of operating payables at end of year2022-12-31$0
Liabilities. Value of operating payables at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$127,020
Value of net assets at end of year (total assets less liabilities)2022-12-31$1,350,862
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,223,842
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$125,996
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$120,785
Value of interest in pooled separate accounts at end of year2022-12-31$125,869
Value of interest in pooled separate accounts at beginning of year2022-12-31$145,608
Interest on participant loans2022-12-31$670
Interest earned on other investments2022-12-31$1,108
Value of interest in common/collective trusts at end of year2022-12-31$909,392
Value of interest in common/collective trusts at beginning of year2022-12-31$878,182
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$72,774
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$66,465
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-27,055
Net investment gain/loss from pooled separate accounts2022-12-31$-37,732
Net investment gain or loss from common/collective trusts2022-12-31$-155,582
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$105,355
Employer contributions (assets) at end of year2022-12-31$105,094
Employer contributions (assets) at beginning of year2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$19,651
Contract administrator fees2022-12-31$14,510
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2022-12-31043499945
2021 : EMERALD HEALTHCARE, LLC 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$303,303
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$110,968
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$76,918
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$149,013
Value of total assets at end of year2021-12-31$1,223,842
Value of total assets at beginning of year2021-12-31$1,031,507
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$34,050
Total interest from all sources2021-12-31$2,111
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$1,227
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$1,227
Administrative expenses professional fees incurred2021-12-31$20,334
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$105,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$126,561
Participant contributions at end of year2021-12-31$12,802
Participant contributions at beginning of year2021-12-31$20,596
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$20,324
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
Other income not declared elsewhere2021-12-31$2,836
Liabilities. Value of operating payables at end of year2021-12-31$0
Liabilities. Value of operating payables at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$192,335
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,223,842
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,031,507
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$120,785
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$110,703
Value of interest in pooled separate accounts at end of year2021-12-31$145,608
Value of interest in pooled separate accounts at beginning of year2021-12-31$120,040
Interest on participant loans2021-12-31$1,090
Interest earned on other investments2021-12-31$1,021
Value of interest in common/collective trusts at end of year2021-12-31$878,182
Value of interest in common/collective trusts at beginning of year2021-12-31$716,906
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$66,465
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$63,262
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$11,807
Net investment gain/loss from pooled separate accounts2021-12-31$30,690
Net investment gain or loss from common/collective trusts2021-12-31$105,619
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$2,128
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$76,918
Contract administrator fees2021-12-31$13,716
Liabilities. Value of benefit claims payable at end of year2021-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Liabilities. Value of acquisition indebtedness at end of year2021-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2021-12-31$0
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2021-12-31043499945
2020 : EMERALD HEALTHCARE, LLC 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 liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$260,502
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$183,182
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$161,301
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Value of total corrective distributions2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$124,669
Value of total assets at end of year2020-12-31$1,031,507
Value of total assets at beginning of year2020-12-31$954,187
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$21,881
Total income from rents2020-12-31$0
Total interest from all sources2020-12-31$2,533
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$340
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$340
Administrative expenses professional fees incurred2020-12-31$4,500
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
Contributions received from participants2020-12-31$124,532
Participant contributions at end of year2020-12-31$20,596
Participant contributions at beginning of year2020-12-31$23,360
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$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$56
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$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Other income not declared elsewhere2020-12-31$216
Administrative expenses (other) incurred2020-12-31$0
Liabilities. Value of operating payables at end of year2020-12-31$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$77,320
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,031,507
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$954,187
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
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$110,703
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$88,221
Value of interest in pooled separate accounts at end of year2020-12-31$120,040
Value of interest in pooled separate accounts at beginning of year2020-12-31$189,395
Interest on participant loans2020-12-31$1,437
Income. Interest from loans (other than to participants)2020-12-31$0
Interest earned on other investments2020-12-31$1,096
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$716,906
Value of interest in common/collective trusts at beginning of year2020-12-31$594,923
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$63,262
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$58,288
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$20,285
Net investment gain/loss from pooled separate accounts2020-12-31$17,517
Net investment gain or loss from common/collective trusts2020-12-31$94,942
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 contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$137
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$161,245
Contract administrator fees2020-12-31$17,381
Liabilities. Value of benefit claims payable at end of year2020-12-31$0
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 end of year2020-12-31$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 name2020-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2020-12-31043499945
2019 : EMERALD HEALTHCARE, LLC 401(K) PLAN 2019 401k financial data
Unrealized appreciation/depreciation of 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 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$293,637
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$131,541
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$104,153
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Value of total corrective distributions2019-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$118,468
Value of total assets at end of year2019-12-31$954,187
Value of total assets at beginning of year2019-12-31$792,091
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$27,388
Total income from rents2019-12-31$0
Total interest from all sources2019-12-31$1,990
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$295
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$295
Administrative expenses professional fees incurred2019-12-31$8,500
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$100,000
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
Contributions received from participants2019-12-31$105,171
Participant contributions at end of year2019-12-31$23,360
Participant contributions at beginning of year2019-12-31$7,032
Participant contributions at end 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$13,064
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 beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$25
Administrative expenses (other) incurred2019-12-31$0
Liabilities. Value of operating payables at end 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
Value of net income/loss2019-12-31$162,096
Value of net assets at end of year (total assets less liabilities)2019-12-31$954,187
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$792,091
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 leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$88,221
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$90,939
Value of interest in pooled separate accounts at end of year2019-12-31$189,395
Value of interest in pooled separate accounts at beginning of year2019-12-31$146,731
Interest on participant loans2019-12-31$1,412
Income. Interest from loans (other than to participants)2019-12-31$0
Interest earned on other investments2019-12-31$578
Income. Interest from US Government securities2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
Value of interest in common/collective trusts at end of year2019-12-31$594,923
Value of interest in common/collective trusts at beginning of year2019-12-31$539,923
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$58,288
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$7,466
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$26,258
Net investment gain/loss from pooled separate accounts2019-12-31$45,291
Net investment gain or loss from common/collective trusts2019-12-31$101,310
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
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$233
Employer contributions (assets) at end 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 common stock2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$104,153
Contract administrator fees2019-12-31$18,888
Liabilities. Value of benefit claims payable at end 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 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
Aggregate proceeds on sale of assets2019-12-31$0
Aggregate carrying amount (costs) on sale of assets2019-12-31$0
Liabilities. Value of acquisition indebtedness at end 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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2019-12-31043499945
2018 : EMERALD HEALTHCARE, LLC 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$76,692
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$37,483
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$18,212
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$135,834
Value of total assets at end of year2018-12-31$792,091
Value of total assets at beginning of year2018-12-31$752,882
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$19,271
Total interest from all sources2018-12-31$378
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$856
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$856
Administrative expenses professional fees incurred2018-12-31$8,985
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$100,000
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
Contributions received from participants2018-12-31$135,489
Participant contributions at end of year2018-12-31$7,032
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$345
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$39,209
Value of net assets at end of year (total assets less liabilities)2018-12-31$792,091
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$752,882
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
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$90,939
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$88,502
Value of interest in pooled separate accounts at end of year2018-12-31$146,731
Value of interest in pooled separate accounts at beginning of year2018-12-31$150,492
Interest on participant loans2018-12-31$288
Interest earned on other investments2018-12-31$90
Value of interest in common/collective trusts at end of year2018-12-31$539,923
Value of interest in common/collective trusts at beginning of year2018-12-31$511,017
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$7,466
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$2,871
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-5,363
Net investment gain/loss from pooled separate accounts2018-12-31$-12,038
Net investment gain or loss from common/collective trusts2018-12-31$-42,975
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 contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$18,212
Contract administrator fees2018-12-31$10,286
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
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 name2018-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2018-12-31043499945
2017 : EMERALD HEALTHCARE, LLC 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$757,161
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$4,279
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$80
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$696,752
Value of total assets at end of year2017-12-31$752,882
Value of total assets at beginning of year2017-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$4,199
Total interest from all sources2017-12-31$15
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$130
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$130
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$10,000
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
Contributions received from participants2017-12-31$87,431
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$609,321
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$752,882
Value of net assets at end of year (total assets less liabilities)2017-12-31$752,882
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
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
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$88,502
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$0
Value of interest in pooled separate accounts at end of year2017-12-31$150,492
Value of interest in pooled separate accounts at beginning of year2017-12-31$0
Interest earned on other investments2017-12-31$15
Value of interest in common/collective trusts at end of year2017-12-31$511,017
Value of interest in common/collective trusts at beginning of year2017-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$2,871
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$5,254
Net investment gain/loss from pooled separate accounts2017-12-31$11,290
Net investment gain or loss from common/collective trusts2017-12-31$43,720
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 contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$80
Contract administrator fees2017-12-31$4,199
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
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 name2017-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2017-12-31043499945

Form 5500 Responses for EMERALD HEALTHCARE, LLC 401(K) PLAN

2022: EMERALD HEALTHCARE, LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: EMERALD HEALTHCARE, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: EMERALD HEALTHCARE, LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
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 benefit arrangement – InsuranceYes
2019: EMERALD HEALTHCARE, LLC 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
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 benefit arrangement – InsuranceYes
2018: EMERALD HEALTHCARE, LLC 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
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 benefit arrangement – InsuranceYes
2017: EMERALD HEALTHCARE, LLC 401(K) PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01First time form 5500 has been submittedYes
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number530232
Policy instance 2
Insurance contract or identification number530232
Number of Individuals Covered1636
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $427
Total amount of fees paid to insurance companyUSD $61
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $427
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered1636
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $242
Total amount of fees paid to insurance companyUSD $35
Are there contracts with allocated funds for individual policies?0
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?Yes
Health Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $242
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number530232
Policy instance 2
Insurance contract or identification number530232
Number of Individuals Covered1071
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $457
Total amount of fees paid to insurance companyUSD $65
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $457
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered1071
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $227
Total amount of fees paid to insurance companyUSD $33
Are there contracts with allocated funds for individual policies?0
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?Yes
Health Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $227
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number530232
Policy instance 2
Insurance contract or identification number530232
Number of Individuals Covered1048
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $544
Total amount of fees paid to insurance companyUSD $78
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $544
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered1048
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $209
Total amount of fees paid to insurance companyUSD $30
Are there contracts with allocated funds for individual policies?0
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?Yes
Health Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $209
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number530232
Policy instance 2
Insurance contract or identification number530232
Number of Individuals Covered1167
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $589
Total amount of fees paid to insurance companyUSD $84
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $589
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered1167
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $74
Total amount of fees paid to insurance companyUSD $11
Are there contracts with allocated funds for individual policies?0
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?Yes
Health Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number530232
Policy instance 2
Insurance contract or identification number530232
Number of Individuals Covered439
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $89
Total amount of fees paid to insurance companyUSD $14
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
Insurance broker nameSBSF
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered439
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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?Yes
Health Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL FEE
Insurance broker organization code?3
Insurance broker nameLEUMI INVESTMENT SERVICES, INC

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