401k Plan data: TABOR STREET GROUP, LLC WELFARE BENEFITS PLAN plan

TABOR STREET GROUP, LLC WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	TABOR STREET GROUP, LLC WELFARE BENEFITS PLAN
Plan identification number	501

TABOR STREET GROUP, LLC WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

TABOR STREET GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: TABOR STREET GROUP, LLC

Employer identification number (EIN): 821743949

NAIC Classification: 333100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TABOR STREET GROUP, LLC WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-01-01 KEVIN KIRKLE
501 2023-01-01
501 2023-01-01 KEVIN KIRKLE

Form 5500 Responses for TABOR STREET GROUP, LLC WELFARE BENEFITS PLAN

2023: TABOR STREET GROUP, LLC WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0CBYK

Policy instance

Insurance contract or identification number	GLTD0CBYK
Number of Individuals Covered	762
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $4,066
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0CBYK

Policy instance

Insurance contract or identification number	GVTL0CBYK
Number of Individuals Covered	335
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $3,964
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUVH0CBYK

Policy instance

Insurance contract or identification number	GUVH0CBYK
Number of Individuals Covered	57
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,333
Total amount of fees paid to insurance company	USD $333
Other welfare benefits provided	VOLUNTARY HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $6,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0CBYK

Policy instance

Insurance contract or identification number	GUDH0CBYK
Number of Individuals Covered	100
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,537
Total amount of fees paid to insurance company	USD $384
Other welfare benefits provided	VOLUNTARY: ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0CBYK

Policy instance

Insurance contract or identification number	GUDE0CBYK
Number of Individuals Covered	59
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,369
Total amount of fees paid to insurance company	USD $342
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $6,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0CBYK

Policy instance

Insurance contract or identification number	GUG 0CBYK
Number of Individuals Covered	762
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $4,090
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

60790-2365

Policy instance

Insurance contract or identification number	60790-2365
Number of Individuals Covered	345
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $5,712
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6090080

Policy instance

Insurance contract or identification number	6090080
Number of Individuals Covered	122
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,629
Total amount of fees paid to insurance company	USD $328
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $21,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0CBYK

Policy instance

Insurance contract or identification number	GLUG0CBYK
Number of Individuals Covered	762
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of fees paid to insurance company	USD $1,405
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0242232

Policy instance

Insurance contract or identification number	0242232
Number of Individuals Covered	1966
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $7,834
Total amount of fees paid to insurance company	USD $2,227
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $430,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TABOR STREET GROUP, LLC
Employer identification number (EIN):	821743949
NAIC Classification:	333100

Plan id#	Filing Submission Date	Name of Administrator
501	2024-01-01	KEVIN KIRKLE
501	2023-01-01
501	2023-01-01	KEVIN KIRKLE