401k Plan data: PK CONTRACTING BLUE CARE HEALTH PROGRAM plan

PK CONTRACTING BLUE CARE HEALTH PROGRAM 401k Plan overview

Plan Name	PK CONTRACTING BLUE CARE HEALTH PROGRAM
Plan identification number	501

PK CONTRACTING BLUE CARE HEALTH PROGRAM Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

P.K. CONTRACTING, LLC has sponsored the creation of one or more 401k plans.

Company Name: P.K. CONTRACTING, LLC

Employer identification number (EIN): 382313864

NAIC Classification: 238300

Additional information about P.K. CONTRACTING, LLC

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 0000-00-00

Company Identification Number: 217905

Legal Registered Office Address: 1965 BARRETT TROY

United States of America (USA)
48084

More information about P.K. CONTRACTING, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PK CONTRACTING BLUE CARE HEALTH PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01

Plan Statistics for PK CONTRACTING BLUE CARE HEALTH PROGRAM

401k plan membership statisitcs for PK CONTRACTING BLUE CARE HEALTH PROGRAM

Measure Date Value
2022: PK CONTRACTING BLUE CARE HEALTH PROGRAM 2022 401k membership
Total participants, beginning-of-year 2022-04-01 103
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 2
Number of retired or separated participants receiving benefits 2022-04-01 0
Number of other retired or separated participants entitled to future benefits 2022-04-01 0
Total of all active and inactive participants 2022-04-01 2

Measure	Date	Value
2022: PK CONTRACTING BLUE CARE HEALTH PROGRAM 2022 401k membership
Total participants, beginning-of-year	2022-04-01	103
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	2
Number of retired or separated participants receiving benefits	2022-04-01	0
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	2

Form 5500 Responses for PK CONTRACTING BLUE CARE HEALTH PROGRAM

2022: PK CONTRACTING BLUE CARE HEALTH PROGRAM 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	First time form 5500 has been submitted	Yes
2022-04-01	Submission has been amended	No
2022-04-01	This submission is the final filing	No
2022-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-04-01	Plan is a collectively bargained plan	No
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

108371

Policy instance

Insurance contract or identification number	108371
Number of Individuals Covered	2
Insurance policy start date	2022-04-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $752
Total amount of fees paid to insurance company	USD $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 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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $740
Insurance broker organization code?	3

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

108371

Policy instance

Insurance contract or identification number	108371
Number of Individuals Covered	239
Insurance policy start date	2022-04-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $29,688
Total amount of fees paid to insurance company	USD $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 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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,500
Insurance broker organization code?	3

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Company Name:	P.K. CONTRACTING, LLC
Employer identification number (EIN):	382313864
NAIC Classification:	238300

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	0000-00-00
Company Identification Number:	217905
Legal Registered Office Address:	1965 BARRETT TROY United States of America (USA) 48084