401k Plan data: RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN plan

RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

RESORT RETAILERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: RESORT RETAILERS, INC.

Employer identification number (EIN): 752241419

NAIC Classification: 447100
NAIC Description: Gasoline Stations, Gas

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 MELODY GUERRERO 2023-12-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-07-01	MELODY GUERRERO	2023-12-19

Plan Statistics for RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 103
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 100
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 100
Number of employers contributing to the scheme 2022-07-01 0

Measure	Date	Value
2022: RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	103
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	100
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	100
Number of employers contributing to the scheme	2022-07-01	0

Form 5500 Responses for RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN

2022: RESORT RETAILERS HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	First time form 5500 has been submitted	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 )

Policy contract number

60017593

Policy instance

Insurance contract or identification number	60017593
Number of Individuals Covered	144
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $43,473
Total amount of fees paid to insurance company	USD $3,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,384,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,473
Amount paid for insurance broker fees	3000
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

UT09358U

Policy instance

Insurance contract or identification number	UT09358U
Number of Individuals Covered	100
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $835
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $8,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $835
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

14040101

Policy instance

Insurance contract or identification number	14040101
Number of Individuals Covered	99
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $4,048
Total amount of fees paid to insurance company	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $67,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,048
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	RESORT RETAILERS, INC.
Employer identification number (EIN):	752241419
NAIC Classification:	447100
NAIC Description:	Gasoline Stations, Gas