401k Plan data: EMPLOYEE INJURY PLAN plan

EMPLOYEE INJURY PLAN 401k Plan overview

Plan Name	EMPLOYEE INJURY PLAN
Plan identification number	502

EMPLOYEE INJURY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

BMS HOLDINGS I, LP has sponsored the creation of one or more 401k plans.

Company Name: BMS HOLDINGS I, LP

Employer identification number (EIN): 751463179

NAIC Classification: 561740
NAIC Description: Carpet and Upholstery Cleaning Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE INJURY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2022-01-01 PRENTISS GREGORIE
502 2021-01-01
502 2021-01-01 PRENTISS GREGORIE
502 2020-01-01
502 2019-01-01
502 2018-01-01 ROBERT SMITH ROBERT SMITH 2019-01-16
502 2017-01-01 BILL BLACKMON BILL BLACKMON 2019-01-16
502 2012-01-01 BILL BLACKMON
502 2011-01-01 BILL BLACKMON
502 2009-01-01 W. G. BLACKMON III

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2022-01-01
502	2022-01-01	PRENTISS GREGORIE
502	2021-01-01
502	2021-01-01	PRENTISS GREGORIE
502	2020-01-01
502	2019-01-01
502	2018-01-01	ROBERT SMITH	ROBERT SMITH	2019-01-16
502	2017-01-01	BILL BLACKMON	BILL BLACKMON	2019-01-16
502	2012-01-01	BILL BLACKMON
502	2011-01-01	BILL BLACKMON
502	2009-01-01	W. G. BLACKMON III

Plan Statistics for EMPLOYEE INJURY PLAN

401k plan membership statisitcs for EMPLOYEE INJURY PLAN

Measure Date Value
2022: EMPLOYEE INJURY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 628
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 650
Total of all active and inactive participants 2022-01-01 650
Total participants 2022-01-01 650
2021: EMPLOYEE INJURY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 722
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 650
Total of all active and inactive participants 2021-01-01 650
Total participants 2021-01-01 650
2020: EMPLOYEE INJURY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 776
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 707
Total of all active and inactive participants 2020-01-01 707
Total participants 2020-01-01 707
2019: EMPLOYEE INJURY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 741
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 776
Total of all active and inactive participants 2019-01-01 776
Total participants 2019-01-01 776
2018: EMPLOYEE INJURY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 781
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 741
Total of all active and inactive participants 2018-01-01 741
Total participants 2018-01-01 741
2017: EMPLOYEE INJURY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 659
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 781
Total of all active and inactive participants 2017-01-01 781
Total participants 2017-01-01 781
2012: EMPLOYEE INJURY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 748
Total of all active and inactive participants 2012-01-01 748
Total participants 2012-01-01 748
2011: EMPLOYEE INJURY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 174
Number of retired or separated participants receiving benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 174
Total participants 2011-01-01 174
2009: EMPLOYEE INJURY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 141
Total of all active and inactive participants 2009-01-01 141
Total participants 2009-01-01 141

Measure	Date	Value
2022: EMPLOYEE INJURY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	628
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	650
Total of all active and inactive participants	2022-01-01	650
Total participants	2022-01-01	650
2021: EMPLOYEE INJURY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	722
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	650
Total of all active and inactive participants	2021-01-01	650
Total participants	2021-01-01	650
2020: EMPLOYEE INJURY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	776
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	707
Total of all active and inactive participants	2020-01-01	707
Total participants	2020-01-01	707
2019: EMPLOYEE INJURY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	741
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	776
Total of all active and inactive participants	2019-01-01	776
Total participants	2019-01-01	776
2018: EMPLOYEE INJURY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	781
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	741
Total of all active and inactive participants	2018-01-01	741
Total participants	2018-01-01	741
2017: EMPLOYEE INJURY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	659
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	781
Total of all active and inactive participants	2017-01-01	781
Total participants	2017-01-01	781
2012: EMPLOYEE INJURY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	748
Total of all active and inactive participants	2012-01-01	748
Total participants	2012-01-01	748
2011: EMPLOYEE INJURY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	174
Number of retired or separated participants receiving benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	174
Total participants	2011-01-01	174
2009: EMPLOYEE INJURY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	141
Total of all active and inactive participants	2009-01-01	141
Total participants	2009-01-01	141

Form 5500 Responses for EMPLOYEE INJURY PLAN

2022: EMPLOYEE INJURY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: EMPLOYEE INJURY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: EMPLOYEE INJURY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: EMPLOYEE INJURY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: EMPLOYEE INJURY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: EMPLOYEE INJURY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: EMPLOYEE INJURY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: EMPLOYEE INJURY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: EMPLOYEE INJURY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

NORTH AMERICAN SPECIALTY INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 29874 )

Policy contract number

EPG130008

Policy instance

Insurance contract or identification number	EPG130008
Number of Individuals Covered	650
Insurance policy start date	2021-11-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $34,164
Total amount of fees paid to insurance company	USD $27,965
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	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 $200,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NORTH AMERICAN SPECIALTY INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 29874 )

Policy contract number

EPG120008

Policy instance

NORTH AMERICAN SPECIALTY INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 29874 )

Policy contract number

EPG110008

Policy instance

NORTH AMERICAN SPECIALTY INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 29874 )

Policy contract number

EPG080008

Policy instance

NORTH AMERICAN SPECIALTY INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 29874 )

Policy contract number

EPG080008

Policy instance

NORTH AMERICAN SPECIALTY INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 29874 )

Policy contract number

EPG080008

Policy instance

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Company Name:	BMS HOLDINGS I, LP
Employer identification number (EIN):	751463179
NAIC Classification:	561740
NAIC Description:	Carpet and Upholstery Cleaning Services