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APPLEGREEN HEALTH & WELFARE PLAN 401k Plan overview

Plan NameAPPLEGREEN HEALTH & WELFARE PLAN
Plan identification number 501

APPLEGREEN HEALTH & WELFARE 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
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

APPLEGREEN US CENTRAL SERVICES has sponsored the creation of one or more 401k plans.

Company Name:APPLEGREEN US CENTRAL SERVICES
Employer identification number (EIN):853325460
NAIC Classification:447100
NAIC Description: Gasoline Stations, Gas

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01BART CHINNICI2023-05-08
5012021-01-01BART CHINNICI2022-05-11

Plan Statistics for APPLEGREEN HEALTH & WELFARE PLAN

401k plan membership statisitcs for APPLEGREEN HEALTH & WELFARE PLAN

Measure Date Value
2022: APPLEGREEN HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01743
Total number of active participants reported on line 7a of the Form 55002022-01-01741
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 participants2022-01-01741
Number of employers contributing to the scheme2022-01-010
2021: APPLEGREEN HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01299
Total number of active participants reported on line 7a of the Form 55002021-01-01743
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01743
Number of employers contributing to the scheme2021-01-010

Form 5500 Responses for APPLEGREEN HEALTH & WELFARE PLAN

2022: APPLEGREEN HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: APPLEGREEN HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number534042
Policy instance 1
Insurance contract or identification number534042
Number of Individuals Covered741
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $30,068
Total amount of fees paid to insurance companyUSD $5,199
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $171,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,068
Amount paid for insurance broker fees5199
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number235204
Policy instance 2
Insurance contract or identification number235204
Number of Individuals Covered1223
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $36,456
Total amount of fees paid to insurance companyUSD $2,732
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $327,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,456
Amount paid for insurance broker fees2696
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION, NON-MONETARY COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number916696
Policy instance 1
Insurance contract or identification number916696
Number of Individuals Covered666
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $138,634
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,371,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $138,634
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number534042
Policy instance 2
Insurance contract or identification number534042
Number of Individuals Covered743
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,239
Total amount of fees paid to insurance companyUSD $1,580
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,239
Amount paid for insurance broker fees1580
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number235204
Policy instance 3
Insurance contract or identification number235204
Number of Individuals Covered1237
Insurance policy start date2021-07-17
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $25,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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