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BELLEVUE CLUB HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameBELLEVUE CLUB HEALTH AND WELFARE PLAN
Plan identification number 503

BELLEVUE CLUB HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

PACIFIC RECREATION ASSOCIATES has sponsored the creation of one or more 401k plans.

Company Name:PACIFIC RECREATION ASSOCIATES
Employer identification number (EIN):411319546
NAIC Classification:713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BELLEVUE CLUB HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01DAWN SPIEGEL2023-07-06
5032021-01-01DAWN SPIEGEL2022-11-21
5032020-01-01DAWN SPIEGEL2022-11-21
5032018-01-01DAWN SPIEGEL2022-11-21
5032017-01-01DONNA GRAY
5032016-01-01DONNA GRAY
5032015-01-01DONNA GRAY
5032014-01-01DONNA GRAY
5032013-01-01DONNA GRAY
5032012-01-01KAREN BRIER
5032011-01-01KAREN BRIER
5032010-01-01KAREN BRIER
5032009-01-01KAREN BRIER
5032009-01-01KAREN BRIER

Plan Statistics for BELLEVUE CLUB HEALTH AND WELFARE PLAN

401k plan membership statisitcs for BELLEVUE CLUB HEALTH AND WELFARE PLAN

Measure Date Value
2022: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01145
Total number of active participants reported on line 7a of the Form 55002022-01-01183
Number of retired or separated participants receiving benefits2022-01-0110
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01193
Number of employers contributing to the scheme2022-01-010
2021: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01188
Total number of active participants reported on line 7a of the Form 55002021-01-01145
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01145
Number of employers contributing to the scheme2021-01-010
2020: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01204
Total number of active participants reported on line 7a of the Form 55002020-01-01188
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01188
Number of employers contributing to the scheme2020-01-010
2018: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01207
Total number of active participants reported on line 7a of the Form 55002018-01-01206
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 participants2018-01-01206
Number of employers contributing to the scheme2018-01-010
2017: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01201
Total number of active participants reported on line 7a of the Form 55002017-01-01202
Number of retired or separated participants receiving benefits2017-01-015
Total of all active and inactive participants2017-01-01207
2016: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01203
Total number of active participants reported on line 7a of the Form 55002016-01-01194
Number of retired or separated participants receiving benefits2016-01-0112
Total of all active and inactive participants2016-01-01206
2015: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01246
Total number of active participants reported on line 7a of the Form 55002015-01-01240
Number of retired or separated participants receiving benefits2015-01-0114
Total of all active and inactive participants2015-01-01254
2014: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01192
Total number of active participants reported on line 7a of the Form 55002014-01-01189
Number of retired or separated participants receiving benefits2014-01-010
Total of all active and inactive participants2014-01-01189
2013: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01189
Total number of active participants reported on line 7a of the Form 55002013-01-01189
Number of retired or separated participants receiving benefits2013-01-013
Total of all active and inactive participants2013-01-01192
2012: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01186
Total number of active participants reported on line 7a of the Form 55002012-01-01186
Number of retired or separated participants receiving benefits2012-01-013
Total of all active and inactive participants2012-01-01189
2011: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01189
Total number of active participants reported on line 7a of the Form 55002011-01-01183
Number of retired or separated participants receiving benefits2011-01-013
Total of all active and inactive participants2011-01-01186
2010: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01181
Total number of active participants reported on line 7a of the Form 55002010-01-01185
Number of retired or separated participants receiving benefits2010-01-014
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01189
2009: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01178
Total number of active participants reported on line 7a of the Form 55002009-01-01165
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01167

Form 5500 Responses for BELLEVUE CLUB HEALTH AND WELFARE PLAN

2022: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: BELLEVUE CLUB HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number908311
Policy instance 1
Insurance contract or identification number908311
Number of Individuals Covered183
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,635
Total amount of fees paid to insurance companyUSD $2,076
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $61,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,635
Amount paid for insurance broker fees2076
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number908311
Policy instance 1
Insurance contract or identification number908311
Number of Individuals Covered145
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,519
Total amount of fees paid to insurance companyUSD $822
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $41,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,519
Amount paid for insurance broker fees822
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number908311
Policy instance 1
Insurance contract or identification number908311
Number of Individuals Covered130
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,565
Total amount of fees paid to insurance companyUSD $450
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $22,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,565
Amount paid for insurance broker fees450
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number908311
Policy instance 1
Insurance contract or identification number908311
Number of Individuals Covered195
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,288
Total amount of fees paid to insurance companyUSD $342
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $33,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,101
Amount paid for insurance broker fees149
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number908311
Policy instance 1
Insurance contract or identification number908311
Number of Individuals Covered194
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,060
Total amount of fees paid to insurance companyUSD $325
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $38,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,060
Amount paid for insurance broker fees325
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTRUEBENEFITS, LLC
NAVIA BENEFIT SOLUTIONS, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberBCB
Policy instance 2
Insurance contract or identification numberBCB
Number of Individuals Covered16
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,795
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
Other welfare benefits providedFLEXIBLE SPENDING ACCOUNT
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 $1,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1795
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTRUEBENEFITS LLC

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