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SIMPLY FASHION STORES HEALTH BENEFIT PLAN 401k Plan overview

Plan NameSIMPLY FASHION STORES HEALTH BENEFIT PLAN
Plan identification number 501

SIMPLY FASHION STORES HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Supplemental unemployment
  • Dental
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

SIMPLY FASHION STORES LTD has sponsored the creation of one or more 401k plans.

Company Name:SIMPLY FASHION STORES LTD
Employer identification number (EIN):631056230
NAIC Classification:448120
NAIC Description:Women's Clothing Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIMPLY FASHION STORES HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012013-01-01SWAPNIL SHAH SWAPNIL SHAH2014-09-17
5012012-01-01RODNEY BARSTEIN
5012011-01-01RODNEY BARSTEIN
5012009-01-01RODNEY BARSTEIN

Plan Statistics for SIMPLY FASHION STORES HEALTH BENEFIT PLAN

401k plan membership statisitcs for SIMPLY FASHION STORES HEALTH BENEFIT PLAN

Measure Date Value
2013: SIMPLY FASHION STORES HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01419
Total number of active participants reported on line 7a of the Form 55002013-01-01321
Total of all active and inactive participants2013-01-01321
Total participants2013-01-01321
2012: SIMPLY FASHION STORES HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01419
Total number of active participants reported on line 7a of the Form 55002012-01-01377
Total of all active and inactive participants2012-01-01377
Total participants2012-01-01377
2011: SIMPLY FASHION STORES HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01506
Total number of active participants reported on line 7a of the Form 55002011-01-01419
Total of all active and inactive participants2011-01-01419
Total participants2011-01-01419
2009: SIMPLY FASHION STORES HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01408
Total number of active participants reported on line 7a of the Form 55002009-01-01464
Total of all active and inactive participants2009-01-01464
Total participants2009-01-01464

Form 5500 Responses for SIMPLY FASHION STORES HEALTH BENEFIT PLAN

2013: SIMPLY FASHION STORES HEALTH BENEFIT 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 benefit arrangement – InsuranceYes
2012: SIMPLY FASHION STORES HEALTH BENEFIT 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 benefit arrangement – InsuranceYes
2011: SIMPLY FASHION STORES HEALTH BENEFIT 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 benefit arrangement – InsuranceYes
2009: SIMPLY FASHION STORES HEALTH BENEFIT 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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201116
Policy instance 2
Insurance contract or identification number201116
Number of Individuals Covered20
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $264
Are there contracts with allocated funds for individual policies?No
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 providedSHORT TERM DISABILITY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $264
Insurance broker nameDAVIS KOPLON
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS3014
Policy instance 1
Insurance contract or identification numberVS3014
Number of Individuals Covered188
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $2,007
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $22,643
Commission paid to Insurance BrokerUSD $2,007
Insurance broker organization code?3
Insurance broker nameMICHAEL J SELIGMAN
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00607937
Policy instance 3
Insurance contract or identification numberG00607937
Number of Individuals Covered46
Insurance policy start date2013-02-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $2,382
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
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 $11,908
Commission paid to Insurance BrokerUSD $2,382
Insurance broker organization code?3
Insurance broker nameDAVID H KOPLON
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS3014
Policy instance 1
Insurance contract or identification numberVS3014
Number of Individuals Covered208
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $2,323
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,308
Commission paid to Insurance BrokerUSD $2,323
Insurance broker organization code?3
Insurance broker nameMICHAEL J SELIGMAN
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201116
Policy instance 2
Insurance contract or identification number201116
Number of Individuals Covered164
Insurance policy start date2012-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $2,000
Life Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $23,791
Commission paid to Insurance BrokerUSD $2,000
Insurance broker nameDAVID KOPLON
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00607937
Policy instance 3
Insurance contract or identification numberG00607937
Number of Individuals Covered47
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $2,593
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,963
Commission paid to Insurance BrokerUSD $2,593
Insurance broker organization code?3
Insurance broker nameDAVID KOPLON
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201116
Policy instance 2
Insurance contract or identification number201116
Number of Individuals Covered29
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $345
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,449
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS3014
Policy instance 1
Insurance contract or identification numberVS3014
Number of Individuals Covered244
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $2,751
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,933
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00607937
Policy instance 3
Insurance contract or identification numberG00607937
Number of Individuals Covered52
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $3,228
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,139
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00607937
Policy instance 3
Insurance contract or identification numberG00607937
Number of Individuals Covered62
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,300
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,499
Commission paid to Insurance BrokerUSD $3,300
Insurance broker organization code?3
Insurance broker nameDAVID H KOPLON
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number201116
Policy instance 2
Insurance contract or identification number201116
Number of Individuals Covered33
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $384
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,840
Commission paid to Insurance BrokerUSD $384
Insurance broker nameDAVID KOPLON
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS3014
Policy instance 1
Insurance contract or identification numberVS3014
Number of Individuals Covered309
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $2,939
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,001
Commission paid to Insurance BrokerUSD $2,939
Insurance broker organization code?3
Insurance broker nameMICHAEL J SELIGMAN

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