401k Plan data: TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 plan

TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 401k Plan overview

Plan Name	TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501
Plan identification number	501

TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

TRI-STATE DISTRIBUTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name: TRI-STATE DISTRIBUTORS, INC.

Employer identification number (EIN): 581503015

NAIC Classification: 423990
NAIC Description: Other Miscellaneous Durable Goods Merchant Wholesalers

Additional information about TRI-STATE DISTRIBUTORS, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2009-05-26

Company Identification Number: 3814453

Legal Registered Office Address: 32-43 70TH STREET
Queens
EAST ELMHURST
United States of America (USA)
11370

More information about TRI-STATE DISTRIBUTORS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-03-01
501 2017-03-01

Plan Statistics for TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501

401k plan membership statisitcs for TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501

Measure Date Value
2018: TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 2018 401k membership
Total participants, beginning-of-year 2018-03-01 117
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 111
Total of all active and inactive participants 2018-03-01 111
Total participants 2018-03-01 111
2017: TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 2017 401k membership
Total participants, beginning-of-year 2017-03-01 115
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 117
Total of all active and inactive participants 2017-03-01 117
Total participants 2017-03-01 117

Measure	Date	Value
2018: TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 2018 401k membership
Total participants, beginning-of-year	2018-03-01	117
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	111
Total of all active and inactive participants	2018-03-01	111
Total participants	2018-03-01	111
2017: TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 2017 401k membership
Total participants, beginning-of-year	2017-03-01	115
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	117
Total of all active and inactive participants	2017-03-01	117
Total participants	2017-03-01	117

Form 5500 Responses for TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501

2018: TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – Insurance	Yes
2017: TRI-STATE DISTRIBUTORS, INC WELFARE EMPLOYEE BENEFIT PLAN 501 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	First time form 5500 has been submitted	Yes
2017-03-01	Submission has been amended	No
2017-03-01	This submission is the final filing	No
2017-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-03-01	Plan is a collectively bargained plan	No
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – Insurance	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

0622075

Policy instance

Insurance contract or identification number	0622075
Number of Individuals Covered	111
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $5,734
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,734
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

G0386

Policy instance

Insurance contract or identification number	G0386
Number of Individuals Covered	152
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $22,244
Total amount of fees paid to insurance company	USD $2,206
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 $729,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

G0385

Policy instance

Insurance contract or identification number	G0385
Number of Individuals Covered	167
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $1,673
Total amount of fees paid to insurance company	USD $165
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	Yes
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 $54,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TRI-STATE DISTRIBUTORS, INC.
Employer identification number (EIN):	581503015
NAIC Classification:	423990
NAIC Description:	Other Miscellaneous Durable Goods Merchant Wholesalers

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2009-05-26
Company Identification Number:	3814453
Legal Registered Office Address:	32-43 70TH STREET Queens EAST ELMHURST United States of America (USA) 11370