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ST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN 401k Plan overview

Plan NameST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN
Plan identification number 501

ST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ST. MAR ENTERPRISES INC has sponsored the creation of one or more 401k plans.

Company Name:ST. MAR ENTERPRISES INC
Employer identification number (EIN):953684385
NAIC Classification:722513
NAIC Description:Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-07-01ROLAND TACTAY2024-04-04
5012022-07-01ROLAND TACTAY2024-04-05
5012021-07-01ROLAND TACTAY2023-04-11

Form 5500 Responses for ST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN

2023: ST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-07-01Type of plan entitySingle employer plan
2023-07-01This submission is the final filingYes
2023-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2023-07-01Plan funding arrangement – InsuranceYes
2023-07-01Plan benefit arrangement – InsuranceYes
2022: ST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: ST MAR ENTERPRISES INC. HEALTH & WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01First time form 5500 has been submittedYes
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99513361001
Policy instance 4
Insurance contract or identification number99513361001
Number of Individuals Covered100
Insurance policy start date2023-07-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $58
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907767 ET AL
Policy instance 6
Insurance contract or identification number907767 ET AL
Number of Individuals Covered23
Insurance policy start date2023-07-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $130
Total amount of fees paid to insurance companyUSD $13
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number907767 ET AL
Policy instance 3
Insurance contract or identification number907767 ET AL
Number of Individuals Covered26
Insurance policy start date2023-07-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $32
Total amount of fees paid to insurance companyUSD $3
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MEDIEXCEL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15347 )
Policy contract numberA728
Policy instance 2
Insurance contract or identification numberA728
Number of Individuals Covered80
Insurance policy start date2023-07-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $491
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number230442
Policy instance 1
Insurance contract or identification number230442
Number of Individuals Covered55
Insurance policy start date2023-07-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C5KQ
Policy instance 5
Insurance contract or identification numberGLUG0C5KQ
Number of Individuals Covered204
Insurance policy start date2023-07-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $24
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDIEXCEL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15347 )
Policy contract numberA728
Policy instance 2
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number907767 ET AL
Policy instance 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99513361001
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C5KQ
Policy instance 5
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number230442
Policy instance 1
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907767 ET AL
Policy instance 6
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907767 ET AL
Policy instance 6
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number651765
Policy instance 5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99513361001
Policy instance 4
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number907767 ET AL
Policy instance 3
MEDIEXCEL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 15347 )
Policy contract numberA728
Policy instance 2
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number230442
Policy instance 1

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