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EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN 401k Plan overview

Plan NameEMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN
Plan identification number 501

EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

EMPIRE EQUIPMENT COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name:EMPIRE EQUIPMENT COMPANY, LLC
Employer identification number (EIN):810867472
NAIC Classification:493100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01

Plan Statistics for EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN

401k plan membership statisitcs for EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN

Measure Date Value
2022: EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01126
Total number of active participants reported on line 7a of the Form 55002022-01-01143
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01143
2021: EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01119
Total number of active participants reported on line 7a of the Form 55002021-01-01125
Number of retired or separated participants receiving benefits2021-01-011
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01126

Form 5500 Responses for EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN

2022: EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: EMPIRE EQUIPMENT COMPANY, LLC ERISA WRAP PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01First time form 5500 has been submittedYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14172417
Policy instance 1
Insurance contract or identification number14172417
Number of Individuals Covered53
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $20,554
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $560,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,554
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00558988
Policy instance 2
Insurance contract or identification number00558988
Number of Individuals Covered143
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $29,333
Total amount of fees paid to insurance companyUSD $8,226
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, ACCIDENT, CANCER, VOL. CI & H
Welfare Benefit Premiums Paid to CarrierUSD $183,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,032
Amount paid for insurance broker fees8226
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number235134
Policy instance 3
Insurance contract or identification number235134
Number of Individuals Covered52
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $19,346
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $424,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,346
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number606908
Policy instance 4
Insurance contract or identification number606908
Number of Individuals Covered14
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,731
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,731
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number041385
Policy instance 5
Insurance contract or identification number041385
Number of Individuals Covered29
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,053
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $235,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,053
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00631240
Policy instance 1
Insurance contract or identification number00631240
Number of Individuals Covered89
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $28,031
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $529,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees18587
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES INCENTIVE COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00558988
Policy instance 2
Insurance contract or identification number00558988
Number of Individuals Covered126
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $28,321
Total amount of fees paid to insurance companyUSD $3,384
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, ACCIDENT, CANCER, VOL. CI & H
Welfare Benefit Premiums Paid to CarrierUSD $174,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,191
Amount paid for insurance broker fees3384
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number235134
Policy instance 3
Insurance contract or identification number235134
Number of Individuals Covered54
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,448
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $348,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,448
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number606908
Policy instance 4
Insurance contract or identification number606908
Number of Individuals Covered15
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,463
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,463
Insurance broker organization code?3

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