401k Plan data: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN plan

TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN
Plan identification number	501

TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

TJM TREVOSE, LLC has sponsored the creation of one or more 401k plans.

Company Name: TJM TREVOSE, LLC

Employer identification number (EIN): 475068057

NAIC Classification: 721110
NAIC Description: Hotels (except Casino Hotels) and Motels

Additional information about TJM TREVOSE, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2015-09-08

Company Identification Number: L15000153497

Legal Registered Office Address: 5801 ULMERTON ROAD

CLEARWATER

33760

More information about TJM TREVOSE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-03-01 MATT BRADLEY 2021-06-02
501 2019-03-01 MATT BRADLEY 2020-04-24
501 2018-03-01 MATT BRADLEY 2020-04-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2020-03-01	MATT BRADLEY	2021-06-02
501	2019-03-01	MATT BRADLEY	2020-04-24
501	2018-03-01	MATT BRADLEY	2020-04-24

Plan Statistics for TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN

401k plan membership statisitcs for TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN

Measure Date Value
2020: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-03-01 128
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 51
Number of retired or separated participants receiving benefits 2020-03-01 0
Number of other retired or separated participants entitled to future benefits 2020-03-01 0
Total of all active and inactive participants 2020-03-01 51
2019: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-03-01 163
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 138
Number of retired or separated participants receiving benefits 2019-03-01 0
Number of other retired or separated participants entitled to future benefits 2019-03-01 0
Total of all active and inactive participants 2019-03-01 138
2018: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-03-01 155
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 163
Number of retired or separated participants receiving benefits 2018-03-01 0
Number of other retired or separated participants entitled to future benefits 2018-03-01 0
Total of all active and inactive participants 2018-03-01 163

Measure	Date	Value
2020: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-03-01	128
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	51
Number of retired or separated participants receiving benefits	2020-03-01	0
Number of other retired or separated participants entitled to future benefits	2020-03-01	0
Total of all active and inactive participants	2020-03-01	51
2019: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-03-01	163
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	138
Number of retired or separated participants receiving benefits	2019-03-01	0
Number of other retired or separated participants entitled to future benefits	2019-03-01	0
Total of all active and inactive participants	2019-03-01	138
2018: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-03-01	155
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	163
Number of retired or separated participants receiving benefits	2018-03-01	0
Number of other retired or separated participants entitled to future benefits	2018-03-01	0
Total of all active and inactive participants	2018-03-01	163

Form 5500 Responses for TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN

2020: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-03-01	Type of plan entity	Single employer plan
2020-03-01	Submission has been amended	No
2020-03-01	This submission is the final filing	No
2020-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-03-01	Plan is a collectively bargained plan	No
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	Submission has been amended	No
2019-03-01	This submission is the final filing	No
2019-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-03-01	Plan is a collectively bargained plan	No
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: TJM PROPERTIES TREVOSE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	First time form 5500 has been submitted	Yes
2018-03-01	Submission has been amended	No
2018-03-01	This submission is the final filing	No
2018-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-03-01	Plan is a collectively bargained plan	No
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-03-01	Plan benefit arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00622192

Policy instance

Insurance contract or identification number	00622192
Number of Individuals Covered	47
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $37,300
Total amount of fees paid to insurance company	USD $7,821
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
Welfare Benefit Premiums Paid to Carrier	USD $177,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,000
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00529870

Policy instance

Insurance contract or identification number	00529870
Number of Individuals Covered	51
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $4,552
Total amount of fees paid to insurance company	USD $421
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	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT; AD&D; CRITICAL ILLNESS; HOSPITAL INDEMNITY
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 Carrier	USD $49,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,552
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00622192

Policy instance

Insurance contract or identification number	00622192
Number of Individuals Covered	121
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $150,838
Total amount of fees paid to insurance company	USD $17,320
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
Welfare Benefit Premiums Paid to Carrier	USD $412,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $103,438
Insurance broker organization code?	3
Amount paid for insurance broker fees	17320
Additional information about fees paid to insurance broker	SERVICE FEES

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00622192

Policy instance

Insurance contract or identification number	00622192
Number of Individuals Covered	142
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $105,323
Total amount of fees paid to insurance company	USD $21,057
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
Welfare Benefit Premiums Paid to Carrier	USD $497,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105,323
Insurance broker organization code?	3
Amount paid for insurance broker fees	21057
Additional information about fees paid to insurance broker	SERVICE FEES

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Company Name:	TJM TREVOSE, LLC
Employer identification number (EIN):	475068057
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2015-09-08
Company Identification Number:	L15000153497
Legal Registered Office Address:	5801 ULMERTON ROAD CLEARWATER 33760