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FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameFAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 503

FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • 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

FAIRWAY INVESTMENTS, INC. has sponsored the creation of one or more 401k plans.

Company Name:FAIRWAY INVESTMENTS, INC.
Employer identification number (EIN):571047289
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032021-08-01
5032020-08-01
5032019-08-01
5032018-08-01
5032017-08-01
5032016-08-01GEORGE COUNTS
5032015-08-01GEORGE COUNTS
5032014-08-01GEORGE COUNTS
5032013-08-01GEORGE COUNTS
5032012-08-01GEORGE L. COUNTS
5032011-08-01GEORGE L COUNTS
5032009-08-01GEORGE L COUNTS JR

Plan Statistics for FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2021: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01104
Total number of active participants reported on line 7a of the Form 55002021-08-01124
Number of retired or separated participants receiving benefits2021-08-010
Number of other retired or separated participants entitled to future benefits2021-08-010
Total of all active and inactive participants2021-08-01124
2020: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-01111
Total number of active participants reported on line 7a of the Form 55002020-08-01104
Number of retired or separated participants receiving benefits2020-08-010
Number of other retired or separated participants entitled to future benefits2020-08-010
Total of all active and inactive participants2020-08-01104
2019: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-01122
Total number of active participants reported on line 7a of the Form 55002019-08-01111
Number of retired or separated participants receiving benefits2019-08-010
Number of other retired or separated participants entitled to future benefits2019-08-010
Total of all active and inactive participants2019-08-01111
2018: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-08-01116
Total number of active participants reported on line 7a of the Form 55002018-08-01122
Number of retired or separated participants receiving benefits2018-08-010
Number of other retired or separated participants entitled to future benefits2018-08-010
Total of all active and inactive participants2018-08-01122
2017: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01115
Total number of active participants reported on line 7a of the Form 55002017-08-01116
Number of retired or separated participants receiving benefits2017-08-010
Number of other retired or separated participants entitled to future benefits2017-08-010
Total of all active and inactive participants2017-08-01116
2016: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01106
Total number of active participants reported on line 7a of the Form 55002016-08-01115
Number of retired or separated participants receiving benefits2016-08-010
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-01115
2015: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01106
Total number of active participants reported on line 7a of the Form 55002015-08-01106
Number of retired or separated participants receiving benefits2015-08-010
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01106
2014: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01120
Total number of active participants reported on line 7a of the Form 55002014-08-01106
Number of retired or separated participants receiving benefits2014-08-010
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01106
2013: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01112
Total number of active participants reported on line 7a of the Form 55002013-08-01120
Number of retired or separated participants receiving benefits2013-08-010
Number of other retired or separated participants entitled to future benefits2013-08-010
Total of all active and inactive participants2013-08-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-08-010
Total participants2013-08-01120
Number of participants with account balances2013-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-08-010
2012: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01112
Total number of active participants reported on line 7a of the Form 55002012-08-01112
Total of all active and inactive participants2012-08-01112
2011: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-01120
Total number of active participants reported on line 7a of the Form 55002011-08-01112
Total of all active and inactive participants2011-08-01112
Total participants2011-08-01112
2009: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01109
Total number of active participants reported on line 7a of the Form 55002009-08-01106
Total of all active and inactive participants2009-08-01106
Total participants2009-08-01106

Financial Data on FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-07-31$258,592
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-07-31$178,195
Total income from all sources (including contributions)2022-07-31$1,351,068
Total of all expenses incurred2022-07-31$1,763,990
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-07-31$1,574,602
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-07-31$1,351,068
Value of total assets at end of year2022-07-31$206,168
Value of total assets at beginning of year2022-07-31$538,693
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-07-31$189,388
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-07-31No
Administrative expenses professional fees incurred2022-07-31$189,388
Was this plan covered by a fidelity bond2022-07-31Yes
Value of fidelity bond cover2022-07-31$500,000
If this is an individual account plan, was there a blackout period2022-07-31No
Were there any nonexempt tranactions with any party-in-interest2022-07-31No
Contributions received from participants2022-07-31$305,574
Assets. Other investments not covered elsewhere at end of year2022-07-31$41,143
Assets. Other investments not covered elsewhere at beginning of year2022-07-31$45,918
Income. Received or receivable in cash from other sources (including rollovers)2022-07-31$14,285
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-07-31$59,606
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-07-31$59,541
Liabilities. Value of operating payables at end of year2022-07-31$23,229
Liabilities. Value of operating payables at beginning of year2022-07-31$16,144
Total non interest bearing cash at end of year2022-07-31$104,553
Total non interest bearing cash at beginning of year2022-07-31$432,578
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-07-31No
Value of net income/loss2022-07-31$-412,922
Value of net assets at end of year (total assets less liabilities)2022-07-31$-52,424
Value of net assets at beginning of year (total assets less liabilities)2022-07-31$360,498
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-07-31No
Were any leases to which the plan was party in default or uncollectible2022-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-07-31$529,046
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-07-31No
Was there a failure to transmit to the plan any participant contributions2022-07-31No
Has the plan failed to provide any benefit when due under the plan2022-07-31No
Contributions received in cash from employer2022-07-31$1,031,209
Employer contributions (assets) at end of year2022-07-31$866
Employer contributions (assets) at beginning of year2022-07-31$656
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-07-31$1,045,556
Liabilities. Value of benefit claims payable at end of year2022-07-31$235,363
Liabilities. Value of benefit claims payable at beginning of year2022-07-31$162,051
Did the plan have assets held for investment2022-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-07-31No
Opinion of an independent qualified public accountant for this plan2022-07-31Unqualified
Accountancy firm name2022-07-31BRADSHAW, GORDAN & CLINKSCALES, LLC
Accountancy firm EIN2022-07-31571060705
2021 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-07-31$178,195
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-07-31$66,288
Total income from all sources (including contributions)2021-07-31$974,092
Total of all expenses incurred2021-07-31$1,242,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-07-31$1,080,957
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-07-31$974,092
Value of total assets at end of year2021-07-31$538,693
Value of total assets at beginning of year2021-07-31$695,243
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-07-31$161,592
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-07-31No
Administrative expenses professional fees incurred2021-07-31$161,592
Was this plan covered by a fidelity bond2021-07-31Yes
Value of fidelity bond cover2021-07-31$500,000
If this is an individual account plan, was there a blackout period2021-07-31No
Were there any nonexempt tranactions with any party-in-interest2021-07-31No
Contributions received from participants2021-07-31$291,350
Assets. Other investments not covered elsewhere at end of year2021-07-31$45,918
Assets. Other investments not covered elsewhere at beginning of year2021-07-31$35,777
Income. Received or receivable in cash from other sources (including rollovers)2021-07-31$8,440
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-07-31$59,541
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-07-31$34,158
Liabilities. Value of operating payables at end of year2021-07-31$16,144
Liabilities. Value of operating payables at beginning of year2021-07-31$29,445
Total non interest bearing cash at end of year2021-07-31$432,578
Total non interest bearing cash at beginning of year2021-07-31$624,315
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-07-31No
Value of net income/loss2021-07-31$-268,457
Value of net assets at end of year (total assets less liabilities)2021-07-31$360,498
Value of net assets at beginning of year (total assets less liabilities)2021-07-31$628,955
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-07-31No
Were any leases to which the plan was party in default or uncollectible2021-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-07-31$381,368
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-07-31No
Was there a failure to transmit to the plan any participant contributions2021-07-31No
Has the plan failed to provide any benefit when due under the plan2021-07-31No
Contributions received in cash from employer2021-07-31$674,302
Employer contributions (assets) at end of year2021-07-31$656
Employer contributions (assets) at beginning of year2021-07-31$993
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-07-31$699,589
Liabilities. Value of benefit claims payable at end of year2021-07-31$162,051
Liabilities. Value of benefit claims payable at beginning of year2021-07-31$36,843
Did the plan have assets held for investment2021-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-07-31No
Opinion of an independent qualified public accountant for this plan2021-07-31Unqualified
Accountancy firm name2021-07-31BRADSHAW, GORDAN & CLINKSCALES, LLC
Accountancy firm EIN2021-07-31571060705
2020 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-07-31$66,288
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-07-31$36,767
Total income from all sources (including contributions)2020-07-31$1,526,765
Total of all expenses incurred2020-07-31$1,135,499
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-07-31$998,382
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-07-31$1,526,760
Value of total assets at end of year2020-07-31$695,243
Value of total assets at beginning of year2020-07-31$274,456
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-07-31$137,117
Total interest from all sources2020-07-31$5
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-07-31No
Administrative expenses professional fees incurred2020-07-31$137,117
Was this plan covered by a fidelity bond2020-07-31Yes
Value of fidelity bond cover2020-07-31$500,000
If this is an individual account plan, was there a blackout period2020-07-31No
Were there any nonexempt tranactions with any party-in-interest2020-07-31No
Contributions received from participants2020-07-31$380,413
Assets. Other investments not covered elsewhere at end of year2020-07-31$35,777
Assets. Other investments not covered elsewhere at beginning of year2020-07-31$4,845
Income. Received or receivable in cash from other sources (including rollovers)2020-07-31$11,440
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-07-31$34,158
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-07-31$8,598
Liabilities. Value of operating payables at end of year2020-07-31$29,445
Liabilities. Value of operating payables at beginning of year2020-07-31$22,897
Total non interest bearing cash at end of year2020-07-31$624,315
Total non interest bearing cash at beginning of year2020-07-31$257,901
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-07-31No
Value of net income/loss2020-07-31$391,266
Value of net assets at end of year (total assets less liabilities)2020-07-31$628,955
Value of net assets at beginning of year (total assets less liabilities)2020-07-31$237,689
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-07-31No
Were any leases to which the plan was party in default or uncollectible2020-07-31No
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-07-31$5
Expenses. Payments to insurance carriers foe the provision of benefits2020-07-31$418,644
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-07-31No
Was there a failure to transmit to the plan any participant contributions2020-07-31No
Has the plan failed to provide any benefit when due under the plan2020-07-31No
Contributions received in cash from employer2020-07-31$1,134,907
Employer contributions (assets) at end of year2020-07-31$993
Employer contributions (assets) at beginning of year2020-07-31$3,112
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-07-31$579,738
Liabilities. Value of benefit claims payable at end of year2020-07-31$36,843
Liabilities. Value of benefit claims payable at beginning of year2020-07-31$13,870
Did the plan have assets held for investment2020-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-07-31No
Opinion of an independent qualified public accountant for this plan2020-07-31Unqualified
Accountancy firm name2020-07-31BRADSHAW, GORDAN & CLINKSCALES, LLC
Accountancy firm EIN2020-07-31571060705
2019 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-07-31$22,897
Total income from all sources (including contributions)2019-07-31$1,181,888
Total of all expenses incurred2019-07-31$1,537,548
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-07-31$1,377,935
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-07-31$1,181,828
Value of total assets at end of year2019-07-31$274,456
Value of total assets at beginning of year2019-07-31$607,219
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-07-31$159,613
Total interest from all sources2019-07-31$60
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-07-31No
Administrative expenses professional fees incurred2019-07-31$159,613
Was this plan covered by a fidelity bond2019-07-31Yes
Value of fidelity bond cover2019-07-31$500,000
If this is an individual account plan, was there a blackout period2019-07-31No
Were there any nonexempt tranactions with any party-in-interest2019-07-31No
Contributions received from participants2019-07-31$332,409
Assets. Other investments not covered elsewhere at end of year2019-07-31$4,845
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-07-31$372,468
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-07-31$8,598
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-07-31$53,408
Liabilities. Value of operating payables at end of year2019-07-31$22,897
Total non interest bearing cash at end of year2019-07-31$257,901
Total non interest bearing cash at beginning of year2019-07-31$551,503
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-07-31No
Value of net income/loss2019-07-31$-355,660
Value of net assets at end of year (total assets less liabilities)2019-07-31$251,559
Value of net assets at beginning of year (total assets less liabilities)2019-07-31$607,219
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-07-31No
Were any leases to which the plan was party in default or uncollectible2019-07-31No
Interest earned on other investments2019-07-31$60
Expenses. Payments to insurance carriers foe the provision of benefits2019-07-31$60,651
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-07-31No
Was there a failure to transmit to the plan any participant contributions2019-07-31No
Has the plan failed to provide any benefit when due under the plan2019-07-31No
Contributions received in cash from employer2019-07-31$849,419
Employer contributions (assets) at end of year2019-07-31$3,112
Employer contributions (assets) at beginning of year2019-07-31$2,308
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-07-31$944,816
Did the plan have assets held for investment2019-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-07-31No
Opinion of an independent qualified public accountant for this plan2019-07-31Unqualified
Accountancy firm name2019-07-31BRADSHAW, GORDAN & CLINKSCALES, LLC
Accountancy firm EIN2019-07-31571060705
2018 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2018 401k financial data
Total income from all sources (including contributions)2018-07-31$1,104,395
Total of all expenses incurred2018-07-31$1,183,883
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-07-31$1,044,500
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-07-31$1,104,395
Value of total assets at end of year2018-07-31$607,219
Value of total assets at beginning of year2018-07-31$686,707
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-07-31$139,383
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-07-31No
Administrative expenses professional fees incurred2018-07-31$139,383
Was this plan covered by a fidelity bond2018-07-31Yes
Value of fidelity bond cover2018-07-31$500,000
If this is an individual account plan, was there a blackout period2018-07-31No
Were there any nonexempt tranactions with any party-in-interest2018-07-31No
Contributions received from participants2018-07-31$326,912
Assets. Other investments not covered elsewhere at beginning of year2018-07-31$29,886
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-07-31$279,925
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-07-31$53,408
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-07-31$24,082
Total non interest bearing cash at end of year2018-07-31$551,503
Total non interest bearing cash at beginning of year2018-07-31$632,645
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-07-31No
Value of net income/loss2018-07-31$-79,488
Value of net assets at end of year (total assets less liabilities)2018-07-31$607,219
Value of net assets at beginning of year (total assets less liabilities)2018-07-31$686,707
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-07-31No
Were any leases to which the plan was party in default or uncollectible2018-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-07-31$58,876
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-07-31No
Was there a failure to transmit to the plan any participant contributions2018-07-31No
Has the plan failed to provide any benefit when due under the plan2018-07-31No
Contributions received in cash from employer2018-07-31$777,483
Employer contributions (assets) at end of year2018-07-31$2,308
Employer contributions (assets) at beginning of year2018-07-31$94
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-07-31$705,699
Did the plan have assets held for investment2018-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-07-31No
Opinion of an independent qualified public accountant for this plan2018-07-31Unqualified
Accountancy firm name2018-07-31BRADSHAW, GORDAN & CLINKSCALES, LLC
Accountancy firm EIN2018-07-31571060705
2017 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-07-31$50,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-07-31$16,218
Total income from all sources (including contributions)2017-07-31$1,065,920
Total of all expenses incurred2017-07-31$1,059,072
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-07-31$873,375
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-07-31$1,065,920
Value of total assets at end of year2017-07-31$686,707
Value of total assets at beginning of year2017-07-31$646,077
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-07-31$185,697
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-07-31No
Administrative expenses professional fees incurred2017-07-31$151,915
Was this plan covered by a fidelity bond2017-07-31Yes
Value of fidelity bond cover2017-07-31$500,000
If this is an individual account plan, was there a blackout period2017-07-31No
Were there any nonexempt tranactions with any party-in-interest2017-07-31No
Contributions received from participants2017-07-31$325,250
Assets. Other investments not covered elsewhere at end of year2017-07-31$29,886
Assets. Other investments not covered elsewhere at beginning of year2017-07-31$27,160
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-07-31$259,548
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-07-31$24,082
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-07-31$84,604
Administrative expenses (other) incurred2017-07-31$33,782
Total non interest bearing cash at end of year2017-07-31$632,645
Total non interest bearing cash at beginning of year2017-07-31$533,208
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-07-31No
Value of net income/loss2017-07-31$6,848
Value of net assets at end of year (total assets less liabilities)2017-07-31$636,707
Value of net assets at beginning of year (total assets less liabilities)2017-07-31$629,859
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-07-31No
Were any leases to which the plan was party in default or uncollectible2017-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-07-31$43,871
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-07-31No
Was there a failure to transmit to the plan any participant contributions2017-07-31No
Has the plan failed to provide any benefit when due under the plan2017-07-31No
Contributions received in cash from employer2017-07-31$740,670
Employer contributions (assets) at end of year2017-07-31$94
Employer contributions (assets) at beginning of year2017-07-31$1,105
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-07-31$569,956
Liabilities. Value of benefit claims payable at end of year2017-07-31$50,000
Liabilities. Value of benefit claims payable at beginning of year2017-07-31$16,218
Did the plan have assets held for investment2017-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-07-31No
Opinion of an independent qualified public accountant for this plan2017-07-31Unqualified
Accountancy firm name2017-07-31GREENE FINNEY, LLP
Accountancy firm EIN2017-07-31522212837
2016 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-07-31$16,218
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-07-31$70,844
Total income from all sources (including contributions)2016-07-31$957,536
Total of all expenses incurred2016-07-31$971,945
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-07-31$876,302
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-07-31$957,536
Value of total assets at end of year2016-07-31$646,077
Value of total assets at beginning of year2016-07-31$715,112
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-07-31$95,643
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-07-31No
Administrative expenses professional fees incurred2016-07-31$150,269
Was this plan covered by a fidelity bond2016-07-31Yes
Value of fidelity bond cover2016-07-31$500,000
If this is an individual account plan, was there a blackout period2016-07-31No
Were there any nonexempt tranactions with any party-in-interest2016-07-31No
Contributions received from participants2016-07-31$246,840
Assets. Other investments not covered elsewhere at end of year2016-07-31$27,160
Assets. Other investments not covered elsewhere at beginning of year2016-07-31$1,943
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-07-31$221,993
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-07-31$84,604
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-07-31$104,006
Administrative expenses (other) incurred2016-07-31$-54,626
Total non interest bearing cash at end of year2016-07-31$533,208
Total non interest bearing cash at beginning of year2016-07-31$608,058
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-07-31No
Value of net income/loss2016-07-31$-14,409
Value of net assets at end of year (total assets less liabilities)2016-07-31$629,859
Value of net assets at beginning of year (total assets less liabilities)2016-07-31$644,268
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-07-31No
Were any leases to which the plan was party in default or uncollectible2016-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-07-31$40,756
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-07-31No
Was there a failure to transmit to the plan any participant contributions2016-07-31No
Has the plan failed to provide any benefit when due under the plan2016-07-31No
Contributions received in cash from employer2016-07-31$710,696
Employer contributions (assets) at end of year2016-07-31$1,105
Employer contributions (assets) at beginning of year2016-07-31$1,105
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-07-31$613,553
Liabilities. Value of benefit claims payable at end of year2016-07-31$16,218
Liabilities. Value of benefit claims payable at beginning of year2016-07-31$70,844
Did the plan have assets held for investment2016-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-07-31No
Opinion of an independent qualified public accountant for this plan2016-07-31Unqualified
Accountancy firm name2016-07-31GREENE FINNEY & HORTON LLP
Accountancy firm EIN2016-07-31522212837
2015 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-07-31$70,844
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-07-31$29,616
Total income from all sources (including contributions)2015-07-31$919,196
Total of all expenses incurred2015-07-31$963,587
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-07-31$754,890
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-07-31$919,103
Value of total assets at end of year2015-07-31$715,112
Value of total assets at beginning of year2015-07-31$718,275
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-07-31$208,697
Total interest from all sources2015-07-31$93
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-07-31No
Administrative expenses professional fees incurred2015-07-31$167,469
Was this plan covered by a fidelity bond2015-07-31Yes
Value of fidelity bond cover2015-07-31$500,000
If this is an individual account plan, was there a blackout period2015-07-31No
Were there any nonexempt tranactions with any party-in-interest2015-07-31No
Contributions received from participants2015-07-31$212,580
Assets. Other investments not covered elsewhere at end of year2015-07-31$1,943
Assets. Other investments not covered elsewhere at beginning of year2015-07-31$3,561
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-07-31$197,426
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-07-31$104,006
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-07-31$34,357
Administrative expenses (other) incurred2015-07-31$41,228
Total non interest bearing cash at end of year2015-07-31$608,058
Total non interest bearing cash at beginning of year2015-07-31$279,305
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-07-31No
Value of net income/loss2015-07-31$-44,391
Value of net assets at end of year (total assets less liabilities)2015-07-31$644,268
Value of net assets at beginning of year (total assets less liabilities)2015-07-31$688,659
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-07-31No
Were any leases to which the plan was party in default or uncollectible2015-07-31No
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-07-31$400,395
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-07-31$400,395
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-07-31$93
Expenses. Payments to insurance carriers foe the provision of benefits2015-07-31$43,775
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-07-31No
Was there a failure to transmit to the plan any participant contributions2015-07-31No
Has the plan failed to provide any benefit when due under the plan2015-07-31No
Contributions received in cash from employer2015-07-31$706,523
Employer contributions (assets) at end of year2015-07-31$1,105
Employer contributions (assets) at beginning of year2015-07-31$657
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-07-31$513,689
Liabilities. Value of benefit claims payable at end of year2015-07-31$70,844
Liabilities. Value of benefit claims payable at beginning of year2015-07-31$29,616
Did the plan have assets held for investment2015-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-07-31No
Opinion of an independent qualified public accountant for this plan2015-07-31Unqualified
Accountancy firm name2015-07-31GREENE FINNEY & HORTON LLP
Accountancy firm EIN2015-07-31522212837
2014 : FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-07-31$29,616
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-07-31$18,919
Total income from all sources (including contributions)2014-07-31$894,963
Total loss/gain on sale of assets2014-07-31$0
Total of all expenses incurred2014-07-31$866,278
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-07-31$736,995
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-07-31$894,310
Value of total assets at end of year2014-07-31$718,275
Value of total assets at beginning of year2014-07-31$678,893
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-07-31$129,283
Total interest from all sources2014-07-31$653
Total dividends received (eg from common stock, registered investment company shares)2014-07-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-07-31No
Administrative expenses professional fees incurred2014-07-31$118,586
Was this plan covered by a fidelity bond2014-07-31Yes
Value of fidelity bond cover2014-07-31$500,000
Were there any nonexempt tranactions with any party-in-interest2014-07-31No
Contributions received from participants2014-07-31$215,652
Assets. Other investments not covered elsewhere at end of year2014-07-31$3,561
Assets. Other investments not covered elsewhere at beginning of year2014-07-31$3,102
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-07-31$167,923
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-07-31$34,357
Administrative expenses (other) incurred2014-07-31$10,697
Total non interest bearing cash at end of year2014-07-31$279,305
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-07-31No
Value of net income/loss2014-07-31$28,685
Value of net assets at end of year (total assets less liabilities)2014-07-31$688,659
Value of net assets at beginning of year (total assets less liabilities)2014-07-31$659,974
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-07-31No
Were any leases to which the plan was party in default or uncollectible2014-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-07-31$400,395
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-07-31$675,134
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-07-31$675,134
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-07-31$653
Expenses. Payments to insurance carriers foe the provision of benefits2014-07-31$46,538
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-07-31No
Was there a failure to transmit to the plan any participant contributions2014-07-31No
Has the plan failed to provide any benefit when due under the plan2014-07-31No
Contributions received in cash from employer2014-07-31$678,658
Employer contributions (assets) at end of year2014-07-31$657
Employer contributions (assets) at beginning of year2014-07-31$657
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-07-31$522,534
Liabilities. Value of benefit claims payable at end of year2014-07-31$29,616
Liabilities. Value of benefit claims payable at beginning of year2014-07-31$18,919
Did the plan have assets held for investment2014-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-07-31No
Opinion of an independent qualified public accountant for this plan2014-07-31Unqualified
Accountancy firm name2014-07-31GREENE, FINNEY & HORTON, LLP
Accountancy firm EIN2014-07-31522212837

Form 5500 Responses for FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN

2021: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Plan funding arrangement – TrustYes
2021-08-01Plan benefit arrangement – InsuranceYes
2021-08-01Plan benefit arrangement - TrustYes
2020: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Plan funding arrangement – TrustYes
2020-08-01Plan benefit arrangement – InsuranceYes
2020-08-01Plan benefit arrangement - TrustYes
2019: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Plan funding arrangement – TrustYes
2019-08-01Plan benefit arrangement – InsuranceYes
2019-08-01Plan benefit arrangement - TrustYes
2018: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Plan funding arrangement – TrustYes
2018-08-01Plan benefit arrangement – InsuranceYes
2018-08-01Plan benefit arrangement - TrustYes
2017: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Plan funding arrangement – TrustYes
2017-08-01Plan benefit arrangement – InsuranceYes
2017-08-01Plan benefit arrangement - TrustYes
2016: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Plan funding arrangement – TrustYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-08-01Plan benefit arrangement - TrustYes
2015: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Plan funding arrangement – TrustYes
2015-08-01Plan benefit arrangement – InsuranceYes
2015-08-01Plan benefit arrangement - TrustYes
2014: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Plan funding arrangement – TrustYes
2014-08-01Plan benefit arrangement – InsuranceYes
2014-08-01Plan benefit arrangement - TrustYes
2013: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – TrustYes
2013-08-01Plan benefit arrangement – InsuranceYes
2013-08-01Plan benefit arrangement - TrustYes
2012: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-08-01Type of plan entityMulti-employer plan
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2009: FAIRWAY FORD, INC HEALTH AND WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-08-01Type of plan entityMulti-employer plan
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered33
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $6,145
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,394
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 2
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered120
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $4,759
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $37,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,869
Additional information about fees paid to insurance brokerLIFE & ADD&D - VOLUNTARY
Insurance broker organization code?3
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered124
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $69,631
Total amount of fees paid to insurance companyUSD $43,259
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $394,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,220
Amount paid for insurance broker fees43259
Additional information about fees paid to insurance brokerSTOP LOSS - TPA COMMISSIONS TPA ADMINSTRATIVE FEES
Insurance broker organization code?5
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered116
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $48,137
Total amount of fees paid to insurance companyUSD $44,133
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $272,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,046
Amount paid for insurance broker fees38733
Additional information about fees paid to insurance brokerSTOP LOSS - TPA COMMISSIONS TPA ADMINSTRATIVE FEES
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 2
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered106
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $4,795
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $37,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,048
Additional information about fees paid to insurance brokerLIFE/AD&D
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered26
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $3,804
Total amount of fees paid to insurance companyUSD $48
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,162
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Amount paid for insurance broker fees26
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered29
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $3,173
Total amount of fees paid to insurance companyUSD $72
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,053
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Amount paid for insurance broker fees40
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered116
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $57,557
Total amount of fees paid to insurance companyUSD $70,694
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $306,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,026
Amount paid for insurance broker fees70694
Additional information about fees paid to insurance brokerSTOP LOSS - TPA COMMISSIONS TPA ADMINSTRATIVE FEES
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 2
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered116
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $4,632
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $36,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,917
Additional information about fees paid to insurance brokerLIFE & ADD&D - VOLUNTARY
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered28
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $3,223
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,058
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 2
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered125
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $4,774
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $37,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,043
Additional information about fees paid to insurance brokerLIFE & ADD&D - VOLUNTARY
Insurance broker organization code?3
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered122
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $55,701
Total amount of fees paid to insurance companyUSD $100,568
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $315,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,567
Amount paid for insurance broker fees100568
Additional information about fees paid to insurance brokerSTOP LOSS - TPA COMMISSIONS TPA ADMINSTRATIVE FEES
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 2
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered116
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $36,693
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $36,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered116
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $41,933
Total amount of fees paid to insurance companyUSD $88,734
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $237,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered26
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $2,802
Total amount of fees paid to insurance companyUSD $208
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered28
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $2,469
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $767
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameJUSTIN GUIDI
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 2
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered115
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $2,380
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,380
Additional information about fees paid to insurance brokerLIFE/AD&D
Insurance broker organization code?3
Insurance broker name
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered106
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $33,186
Total amount of fees paid to insurance companyUSD $90,693
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,124
Amount paid for insurance broker fees5204
Additional information about fees paid to insurance brokerHEALTH, 125 BROKER COMMISSIONS STOP LOSS
Insurance broker organization code?3
Insurance broker namePLANNED ADMINISTRATORS INC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered28
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $2,572
Total amount of fees paid to insurance companyUSD $325
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $807
Amount paid for insurance broker fees202
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameANN J COLLIER
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 2
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered115
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $1,111
Total amount of fees paid to insurance companyUSD $1,111
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,111
Amount paid for insurance broker fees1111
Additional information about fees paid to insurance brokerLIFE/AD&D
Insurance broker organization code?3
Insurance broker name
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered106
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $29,547
Total amount of fees paid to insurance companyUSD $29,547
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,698
Amount paid for insurance broker fees19698
Additional information about fees paid to insurance brokerHEALTH, 125 BROKER COMMISSIONS STOP LOSS
Insurance broker organization code?3
Insurance broker namePLANNED ADMINISTRATORS INC
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 1
Insurance contract or identification number589
Number of Individuals Covered120
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $25,072
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,715
Amount paid for insurance broker fees16715
Additional information about fees paid to insurance brokerHEALTH, 125 BROKER COMMISSIONS-STOP LOSS
Insurance broker organization code?3
Insurance broker namePLANNED ADMINISTRATORS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUGAOAB56
Policy instance 2
Insurance contract or identification numberGLUGAOAB56
Number of Individuals Covered112
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $2,322
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $659
Additional information about fees paid to insurance brokerLIFE; AD&D
Insurance broker organization code?3
Insurance broker nameHUFFMAN & ASSOCIATES, INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered0
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $6,392
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Amount paid for insurance broker fees21
Insurance broker nameCOY L. HUFFMAN,III
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AB56
Policy instance 1
Insurance contract or identification numberGLUG0AB56
Number of Individuals Covered114
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $2,247
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, ST DISAB
Welfare Benefit Premiums Paid to CarrierUSD $20,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $655
Additional information about fees paid to insurance brokerLIFE & ADD AGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameHUFFMAN & ASSOCIATES, INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $3,697
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $14,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,247
Additional information about fees paid to insurance brokerCOMMISSION PAID
Insurance broker organization code?3
Insurance broker nameLARA K CARLSON
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 2
Insurance contract or identification number589
Number of Individuals Covered112
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $24,473
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedFLEXIBLE SPENDING
Welfare Benefit Premiums Paid to CarrierUSD $138,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,157
Additional information about fees paid to insurance brokerHEALTH, FLEX SPENDING TPA COMMISSIONS-STOP LOSS
Insurance broker organization code?5
Insurance broker nameHUFFMAN & ASSOC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered21
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $2,071
Total amount of fees paid to insurance companyUSD $50
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $13,834
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOAB56
Policy instance 1
Insurance contract or identification numberGOOOAB56
Insurance policy start date2011-08-01
Insurance policy end date2012-08-01
Total amount of commissions paid to insurance brokerUSD $3,487
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLIFE ADD, SHORT TERM DISABILITY, LONG TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $28,963
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 2
Insurance contract or identification number589
Number of Individuals Covered112
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $27,746
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedFLEXIBLE SPENDING ACCOUNT
Welfare Benefit Premiums Paid to CarrierUSD $157,228
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKT339
Policy instance 3
Insurance contract or identification numberKT339
Number of Individuals Covered26
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $2,828
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $16,543
PAI (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract number589
Policy instance 2
Insurance contract or identification number589
Number of Individuals Covered120
Insurance policy start date2010-08-01
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $8,446
Total amount of fees paid to insurance companyUSD $16,944
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedFLEXIBLE SPENDING ACCOUNT
Welfare Benefit Premiums Paid to CarrierUSD $143,896
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOOAB56
Policy instance 1
Insurance contract or identification numberGOOOAB56
Total amount of commissions paid to insurance brokerUSD $4,394
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLIFE ADD, SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $34,848

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