401k Plan data: EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION plan

EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION 401k Plan overview

Plan Name	EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION
Plan identification number	506

EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION Benefits

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

401k Sponsoring company profile

EMPLOYER SOLUTIONS GROUP has sponsored the creation of one or more 401k plans.

Company Name: EMPLOYER SOLUTIONS GROUP

Employer identification number (EIN): 870501039

NAIC Classification: 561300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2015-04-01 MARY TWOHILL MARY TWOHILL 2016-10-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
506	2015-04-01	MARY TWOHILL		MARY TWOHILL	2016-10-18

Plan Statistics for EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION

401k plan membership statisitcs for EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION

Measure Date Value
2015: EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION 2015 401k membership
Total participants, beginning-of-year 2015-04-01 1,211
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 1,016
Total of all active and inactive participants 2015-04-01 1,016
Total participants 2015-04-01 1,016

Measure	Date	Value
2015: EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION 2015 401k membership
Total participants, beginning-of-year	2015-04-01	1,211
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	1,016
Total of all active and inactive participants	2015-04-01	1,016
Total participants	2015-04-01	1,016

Form 5500 Responses for EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION

2015: EMPLOYER SOLUTIONS GROUP MEDICAL, DENTAL, VISION 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Submission has been amended	No
2015-04-01	This submission is the final filing	No
2015-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-04-01	Plan is a collectively bargained plan	No
2015-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

531490

Policy instance

Insurance contract or identification number	531490
Number of Individuals Covered	944
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $44
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 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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $430,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44
Insurance broker organization code?	3
Insurance broker name	ASPEN COVE - DASTRUP INS INC

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

531490

Policy instance

Insurance contract or identification number	531490
Number of Individuals Covered	72
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $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 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	Yes
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
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 $486,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	ASPEN COVE - DASTRUP INS INC

Potentially related plans

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Company Name:	EMPLOYER SOLUTIONS GROUP
Employer identification number (EIN):	870501039
NAIC Classification:	561300