401k Plan data: LEGENDS FURNITURE, INC plan

LEGENDS FURNITURE, INC 401k Plan overview

Plan Name	LEGENDS FURNITURE, INC
Plan identification number	501

LEGENDS FURNITURE, INC 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)

401k Sponsoring company profile

LEGENDS FURNITURE, INC has sponsored the creation of one or more 401k plans.

Company Name: LEGENDS FURNITURE, INC

Employer identification number (EIN): 860664645

NAIC Classification: 337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEGENDS FURNITURE, INC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-08-01 SHANKAR RATHNAM 2022-05-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-08-01	SHANKAR RATHNAM	2022-05-12

Plan Statistics for LEGENDS FURNITURE, INC

401k plan membership statisitcs for LEGENDS FURNITURE, INC

Measure Date Value
2020: LEGENDS FURNITURE, INC 2020 401k membership
Total participants, beginning-of-year 2020-08-01 109
Total number of active participants reported on line 7a of the Form 5500 2020-08-01 103
Number of retired or separated participants receiving benefits 2020-08-01 0
Number of other retired or separated participants entitled to future benefits 2020-08-01 0
Total of all active and inactive participants 2020-08-01 103
Number of employers contributing to the scheme 2020-08-01 0

Measure	Date	Value
2020: LEGENDS FURNITURE, INC 2020 401k membership
Total participants, beginning-of-year	2020-08-01	109
Total number of active participants reported on line 7a of the Form 5500	2020-08-01	103
Number of retired or separated participants receiving benefits	2020-08-01	0
Number of other retired or separated participants entitled to future benefits	2020-08-01	0
Total of all active and inactive participants	2020-08-01	103
Number of employers contributing to the scheme	2020-08-01	0

Form 5500 Responses for LEGENDS FURNITURE, INC

2020: LEGENDS FURNITURE, INC 2020 form 5500 responses
2020-08-01	Type of plan entity	Single employer plan
2020-08-01	First time form 5500 has been submitted	Yes
2020-08-01	Plan funding arrangement – Insurance	Yes
2020-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

149868

Policy instance

Insurance contract or identification number	149868
Number of Individuals Covered	104
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $1,909
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,909
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1129962

Policy instance

Insurance contract or identification number	1129962
Number of Individuals Covered	152
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $10,307
Total amount of fees paid to insurance company	USD $1,372
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $66,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,979
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

C8223554

Policy instance

Insurance contract or identification number	C8223554
Number of Individuals Covered	49
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $7,725
Total amount of fees paid to insurance company	USD $2,045
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $18,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,379
Amount paid for insurance broker fees	763
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

BANNER HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16058 )

Policy contract number

149868BH

Policy instance

Insurance contract or identification number	149868BH
Number of Individuals Covered	85
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $20,564
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $350,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	20564
Additional information about fees paid to insurance broker	2020 Q3 BANNER HEALTH JOINT VENTURE BONUS- MEDICAL RISK DIRECT COMPENSATION
Insurance broker organization code?	3

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Company Name:	LEGENDS FURNITURE, INC
Employer identification number (EIN):	860664645
NAIC Classification:	337000