401k Plan data: LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM plan

LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM 401k Plan overview

Plan Name	LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM
Plan identification number	504

LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

LUIS GARRATON, INC. has sponsored the creation of one or more 401k plans.

Company Name: LUIS GARRATON, INC.

Employer identification number (EIN): 660719285

NAIC Classification: 424210
NAIC Description: Drugs and Druggists' Sundries Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2017-09-01 MARIO FORNES DECHETH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2017-09-01	MARIO FORNES DECHETH

Plan Statistics for LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM

401k plan membership statisitcs for LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM

Measure Date Value
2017: LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM 2017 401k membership
Total participants, beginning-of-year 2017-09-01 125
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 125
Total of all active and inactive participants 2017-09-01 125
Total participants 2017-09-01 125

Measure	Date	Value
2017: LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM 2017 401k membership
Total participants, beginning-of-year	2017-09-01	125
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	125
Total of all active and inactive participants	2017-09-01	125
Total participants	2017-09-01	125

Form 5500 Responses for LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM

2017: LUIS GARRATON, INC. - EMPLOYEE ASSISTANCE PROGRAM 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	First time form 5500 has been submitted	Yes
2017-09-01	Submission has been amended	No
2017-09-01	This submission is the final filing	No
2017-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-09-01	Plan is a collectively bargained plan	No
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

INSPIRA MENTAL HEALTH MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 62133 )

Policy contract number

N/A

Policy instance

Insurance contract or identification number	N/A
Number of Individuals Covered	125
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $148
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
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 Carrier	USD $2,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	LUIS GARRATON, INC.
Employer identification number (EIN):	660719285
NAIC Classification:	424210
NAIC Description:	Drugs and Druggists' Sundries Merchant Wholesalers