401k Plan data: ASSISTED RESIDENTIAL SERVICES INC WELFARE BENEFIT PLAN plan

ASSISTED RESIDENTIAL SERVICES INC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ASSISTED RESIDENTIAL SERVICES INC WELFARE BENEFIT PLAN
Plan identification number	501

ASSISTED RESIDENTIAL SERVICES INC WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='461009007' AND PlanID='501'

401k Sponsoring company profile

ASSISTED RESIDENTIAL SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: ASSISTED RESIDENTIAL SERVICES, INC.

Employer identification number (EIN): 461009007

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about ASSISTED RESIDENTIAL SERVICES, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2012-08-20

Company Identification Number: 603231708

Legal Registered Office Address: 9317 E SINTO AVE SUITE 100

SPOKANE VLY
United States of America (USA)
992064034

More information about ASSISTED RESIDENTIAL SERVICES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ASSISTED RESIDENTIAL SERVICES INC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 RACHELL REDMAN 2024-04-16
501 2022-03-01 RACHELL REDMAN 2023-07-12
501 2021-03-01 RACHELL REDMAN 2022-08-15
501 2020-03-01 RACHELL REDMAN 2021-10-01
501 2019-03-01 RACHELL REDMAN 2020-07-28
501 2018-03-01 RACHELL REDMAN 2019-10-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	RACHELL REDMAN	2024-04-16
501	2022-03-01	RACHELL REDMAN	2023-07-12
501	2021-03-01	RACHELL REDMAN	2022-08-15
501	2020-03-01	RACHELL REDMAN	2021-10-01
501	2019-03-01	RACHELL REDMAN	2020-07-28
501	2018-03-01	RACHELL REDMAN	2019-10-24

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BBLZ

Policy instance

Insurance contract or identification number	GLUG0BBLZ
Number of Individuals Covered	114
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $2,768
Total amount of fees paid to insurance company	USD $851
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $18,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30058409

Policy instance

Insurance contract or identification number	30058409
Number of Individuals Covered	55
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $758
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

12232

Policy instance

Insurance contract or identification number	12232
Number of Individuals Covered	105
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $2,998
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6749500

Policy instance

Insurance contract or identification number	6749500
Number of Individuals Covered	79
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $25,614
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $518,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

4098700

Policy instance

Insurance contract or identification number	4098700
Number of Individuals Covered	29
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $809
Total amount of fees paid to insurance company	USD $232
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4098700

Policy instance

Insurance contract or identification number	4098700
Number of Individuals Covered	24
Insurance policy start date	2022-02-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $4,158
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6749500

Policy instance

Insurance contract or identification number	6749500
Number of Individuals Covered	71
Insurance policy start date	2022-02-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $14,929
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $287,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

12232

Policy instance

Insurance contract or identification number	12232
Number of Individuals Covered	91
Insurance policy start date	2022-03-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $1,414
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30058409

Policy instance

Insurance contract or identification number	30058409
Number of Individuals Covered	50
Insurance policy start date	2022-03-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $366
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BBLZ

Policy instance

Insurance contract or identification number	GLUG0BBLZ
Number of Individuals Covered	92
Insurance policy start date	2022-02-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $1,664
Total amount of fees paid to insurance company	USD $1,023
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $11,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BBLZ

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30058409

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

12232

Policy instance

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6749500

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4098700

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BBLZ

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30058409

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

12232

Policy instance

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6749500

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4098700

Policy instance

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6749500

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

12232

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30058409

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BBLZ

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4098700

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4098700

Policy instance

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6749500

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30058409

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BBLZ

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

12232

Policy instance

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Company Name:	ASSISTED RESIDENTIAL SERVICES, INC.
Employer identification number (EIN):	461009007
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2012-08-20
Company Identification Number:	603231708
Legal Registered Office Address:	9317 E SINTO AVE SUITE 100 SPOKANE VLY United States of America (USA) 992064034