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ERIK'S BIKE SHOP, INC MEDICAL PLAN 401k Plan overview

Plan NameERIK'S BIKE SHOP, INC MEDICAL PLAN
Plan identification number 501

ERIK'S BIKE SHOP, INC MEDICAL PLAN Benefits

401k Plan TypeWelfare 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.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ERIK'S BIKE SHOP, INC. has sponsored the creation of one or more 401k plans.

Company Name:ERIK'S BIKE SHOP, INC.
Employer identification number (EIN):411458699
NAIC Classification:451110
NAIC Description:Sporting Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ERIK'S BIKE SHOP, INC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01DOUGLAS HOLTZ2020-03-24
5012018-01-01
5012017-11-01
5012016-11-01

Plan Statistics for ERIK'S BIKE SHOP, INC MEDICAL PLAN

401k plan membership statisitcs for ERIK'S BIKE SHOP, INC MEDICAL PLAN

Measure Date Value
2019: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01100
Total number of active participants reported on line 7a of the Form 55002019-01-0196
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0196
Number of employers contributing to the scheme2019-01-010
2018: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01110
Total number of active participants reported on line 7a of the Form 55002018-01-0198
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 participants2018-01-0198
Number of employers contributing to the scheme2018-01-010
2017: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01110
Total number of active participants reported on line 7a of the Form 55002017-11-01109
Number of retired or separated participants receiving benefits2017-11-010
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01109
2016: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01100
Total number of active participants reported on line 7a of the Form 55002016-11-0194
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-0194

Form 5500 Responses for ERIK'S BIKE SHOP, INC MEDICAL PLAN

2019: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: ERIK'S BIKE SHOP, INC MEDICAL PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01First time form 5500 has been submittedYes
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PREFERREDONE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11817 )
Policy contract numberPCH10411
Policy instance 1
Insurance contract or identification numberPCH10411
Number of Individuals Covered124
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $394,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREFERREDONE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11817 )
Policy contract numberPCH10411
Policy instance 1
Insurance contract or identification numberPCH10411
Number of Individuals Covered124
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $414,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREFERREDONE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11817 )
Policy contract numberPCH10411
Policy instance 1
Insurance contract or identification numberPCH10411
Number of Individuals Covered132
Insurance policy start date2017-11-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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