401k Plan data: SILVERADO STAGES CAFETERIA BENEFIT PLAN plan

SILVERADO STAGES CAFETERIA BENEFIT PLAN 401k Plan overview

Plan Name	SILVERADO STAGES CAFETERIA BENEFIT PLAN
Plan identification number	502

SILVERADO STAGES CAFETERIA BENEFIT PLAN Benefits

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

401k Sponsoring company profile

SILVERADO STAGES, INC. has sponsored the creation of one or more 401k plans.

Company Name: SILVERADO STAGES, INC.

Employer identification number (EIN): 770366904

NAIC Classification: 485510
NAIC Description: Charter Bus Industry

Additional information about SILVERADO STAGES, INC.

Jurisdiction of Incorporation: Wyoming Corporations Division

Incorporation Date: 2015-05-14

Company Identification Number: 000686854

Legal Registered Office Address: 2239 N Black Canyon Hwy

Phoenix
United States of America (USA)
85009

More information about SILVERADO STAGES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SILVERADO STAGES CAFETERIA BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-05-01 NICOLE BAKER NICOLE BAKER 2018-09-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2017-05-01	NICOLE BAKER		NICOLE BAKER	2018-09-04

Plan Statistics for SILVERADO STAGES CAFETERIA BENEFIT PLAN

401k plan membership statisitcs for SILVERADO STAGES CAFETERIA BENEFIT PLAN

Measure Date Value
2017: SILVERADO STAGES CAFETERIA BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-05-01 131
Total number of active participants reported on line 7a of the Form 5500 2017-05-01 131
Total of all active and inactive participants 2017-05-01 131

Measure	Date	Value
2017: SILVERADO STAGES CAFETERIA BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-05-01	131
Total number of active participants reported on line 7a of the Form 5500	2017-05-01	131
Total of all active and inactive participants	2017-05-01	131

Form 5500 Responses for SILVERADO STAGES CAFETERIA BENEFIT PLAN

2017: SILVERADO STAGES CAFETERIA BENEFIT PLAN 2017 form 5500 responses
2017-05-01	Type of plan entity	Single employer plan
2017-05-01	Submission has been amended	No
2017-05-01	This submission is the final filing	No
2017-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-05-01	Plan is a collectively bargained plan	No
2017-05-01	Plan funding arrangement – Insurance	Yes
2017-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-05-01	Plan benefit arrangement – Insurance	Yes
2017-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

31642

Policy instance

Insurance contract or identification number	31642
Number of Individuals Covered	111
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $28,221
Total amount of fees paid to insurance company	USD $0
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	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 $663,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,863
Insurance broker organization code?	3
Insurance broker name	BENEFIT LOGIC INC

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

Policy contract number

00512147

Policy instance

Insurance contract or identification number	00512147
Number of Individuals Covered	193
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $8,291
Total amount of fees paid to insurance company	USD $0
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	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D, VOLUNTARY 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 $97,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,180
Insurance broker organization code?	3
Insurance broker name	NATIONAL BENEFIT CENTER

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30057727

Policy instance

Insurance contract or identification number	30057727
Number of Individuals Covered	145
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $829
Total amount of fees paid to insurance company	USD $0
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	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 $12,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $506
Insurance broker organization code?	3
Insurance broker name	BENEFIT LOGIC, INC

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Company Name:	SILVERADO STAGES, INC.
Employer identification number (EIN):	770366904
NAIC Classification:	485510
NAIC Description:	Charter Bus Industry

Jurisdiction of Incorporation:	Wyoming Corporations Division
Incorporation Date:	2015-05-14
Company Identification Number:	000686854
Legal Registered Office Address:	2239 N Black Canyon Hwy Phoenix United States of America (USA) 85009