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THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameTHE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN
Plan identification number 501

THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

ROOSEVELT HOTEL LLC has sponsored the creation of one or more 401k plans.

Company Name:ROOSEVELT HOTEL LLC
Employer identification number (EIN):954715049
NAIC Classification:721110
NAIC Description:Hotels (except Casino Hotels) and Motels

Additional information about ROOSEVELT HOTEL LLC

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: 200010810116

More information about ROOSEVELT HOTEL LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-06-01WADEH CONSTANCE
5012016-06-01
5012015-06-01
5012015-04-01

Plan Statistics for THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN

Measure Date Value
2017: THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01400
Total number of active participants reported on line 7a of the Form 55002017-06-010
Total of all active and inactive participants2017-06-010
2016: THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01378
Total number of active participants reported on line 7a of the Form 55002016-06-01400
Total of all active and inactive participants2016-06-01400
2015: THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01265
Total number of active participants reported on line 7a of the Form 55002015-06-01378
Total of all active and inactive participants2015-06-01378
Total participants, beginning-of-year2015-04-01204
Total number of active participants reported on line 7a of the Form 55002015-04-01265
Total of all active and inactive participants2015-04-01265

Form 5500 Responses for THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN

2017: THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingYes
2017-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-06-01Plan is a collectively bargained planNo
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: THE HOLLYWOOD ROOSEVELT EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-04-01Type of plan entitySingle employer plan
2015-04-01First time form 5500 has been submittedYes
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CLAREMONT (National Association of Insurance Commissioners NAIC id number: 61171 )
Policy contract number14860
Policy instance 1
Insurance contract or identification number14860
Number of Individuals Covered400
Insurance policy start date2017-06-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
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 CarrierUSD $1,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number232600
Policy instance 2
Insurance contract or identification number232600
Number of Individuals Covered157
Insurance policy start date2017-06-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $9,178
Total amount of fees paid to insurance companyUSD $8
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $238,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,178
Insurance broker organization code?3
Amount paid for insurance broker fees8
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker nameBROWN & BROWN INS SVCS OF CA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30067305
Policy instance 3
Insurance contract or identification number30067305
Number of Individuals Covered82
Insurance policy start date2017-06-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $391
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $3,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $391
Insurance broker organization code?3
Insurance broker nameEXECUTIVE FINANCIAL BENEFACTS

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