401k Plan data: TN TENNESSEE HEALTH & WELFARE PLAN plan

TN TENNESSEE HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	TN TENNESSEE HEALTH & WELFARE PLAN
Plan identification number	501

TN TENNESSEE HEALTH & WELFARE 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) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

TN TENNESSEE, LLC has sponsored the creation of one or more 401k plans.

Company Name: TN TENNESSEE, LLC

Employer identification number (EIN): 822328206

NAIC Classification: 332110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TN TENNESSEE HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-01-01 TREVOR LYNCH
501 2017-08-17 TREVOR LYNCH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-01-01	TREVOR LYNCH
501	2017-08-17	TREVOR LYNCH

Plan Statistics for TN TENNESSEE HEALTH & WELFARE PLAN

401k plan membership statisitcs for TN TENNESSEE HEALTH & WELFARE PLAN

Measure Date Value
2018: TN TENNESSEE HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 315
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 472
Number of retired or separated participants receiving benefits 2018-01-01 6
Number of other retired or separated participants entitled to future benefits 2018-01-01 12
Total of all active and inactive participants 2018-01-01 490
2017: TN TENNESSEE HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-08-17 294
Total number of active participants reported on line 7a of the Form 5500 2017-08-17 315
Number of retired or separated participants receiving benefits 2017-08-17 0
Number of other retired or separated participants entitled to future benefits 2017-08-17 0
Total of all active and inactive participants 2017-08-17 315

Measure	Date	Value
2018: TN TENNESSEE HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	315
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	472
Number of retired or separated participants receiving benefits	2018-01-01	6
Number of other retired or separated participants entitled to future benefits	2018-01-01	12
Total of all active and inactive participants	2018-01-01	490
2017: TN TENNESSEE HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-08-17	294
Total number of active participants reported on line 7a of the Form 5500	2017-08-17	315
Number of retired or separated participants receiving benefits	2017-08-17	0
Number of other retired or separated participants entitled to future benefits	2017-08-17	0
Total of all active and inactive participants	2017-08-17	315

Form 5500 Responses for TN TENNESSEE HEALTH & WELFARE PLAN

2018: TN TENNESSEE HEALTH & WELFARE 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 – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: TN TENNESSEE HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-08-17	Type of plan entity	Single employer plan
2017-08-17	First time form 5500 has been submitted	Yes
2017-08-17	Submission has been amended	No
2017-08-17	This submission is the final filing	No
2017-08-17	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-08-17	Plan is a collectively bargained plan	No
2017-08-17	Plan funding arrangement – Insurance	Yes
2017-08-17	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

901303

Policy instance

Insurance contract or identification number	901303
Number of Individuals Covered	314
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $39,709
Total amount of fees paid to insurance company	USD $2,523
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $265,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,709
Insurance broker organization code?	3
Amount paid for insurance broker fees	2523
Additional information about fees paid to insurance broker	BONUS

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

Policy contract number

10147751001

Policy instance

Insurance contract or identification number	10147751001
Number of Individuals Covered	590
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,341
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 $33,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,341
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

901303

Policy instance

Insurance contract or identification number	901303
Number of Individuals Covered	629
Insurance policy start date	2017-08-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,835
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	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $93,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,835
Insurance broker organization code?	3
Insurance broker name	WILLIS OF TENNESSEE INC

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Company Name:	TN TENNESSEE, LLC
Employer identification number (EIN):	822328206
NAIC Classification:	332110