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| Plan Name | PALMEN MOTORS, INC. GROUP HEALTH PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PALMEN MOTORS, INC. |
| Employer identification number (EIN): | 391156658 |
| NAIC Classification: | 441110 |
| NAIC Description: | New Car Dealers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2018-01-01 | ||||
| 501 | 2017-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2018: PALMEN MOTORS, INC. GROUP HEALTH PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 224 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 239 |
| Total of all active and inactive participants | 2018-01-01 | 239 |
| 2017: PALMEN MOTORS, INC. GROUP HEALTH PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 224 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 1 |
| Total of all active and inactive participants | 2017-01-01 | 225 |
| 2018: PALMEN MOTORS, INC. GROUP HEALTH PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: PALMEN MOTORS, INC. GROUP HEALTH PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 ) | |||||||||||||||||||||||
| Policy contract number | 00253095 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) | |||||||||||||||||||||||
| Policy contract number | 00253095 | ||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||
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| WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 ) | |||||||||||||||||||||||
| Policy contract number | 10010721 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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