401k Plan data: SEVENTY FIVE STATE STREET plan

SEVENTY FIVE STATE STREET 401k Plan overview

Plan Name	SEVENTY FIVE STATE STREET
Plan identification number	501

SEVENTY FIVE STATE STREET Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Long-term disability cover

401k Sponsoring company profile

SEVENTY-FIVE STATE STREET has sponsored the creation of one or more 401k plans.

Company Name: SEVENTY-FIVE STATE STREET

Employer identification number (EIN): 010211791

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SEVENTY FIVE STATE STREET

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 LORI MAXWELL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	LORI MAXWELL

Plan Statistics for SEVENTY FIVE STATE STREET

401k plan membership statisitcs for SEVENTY FIVE STATE STREET

Measure Date Value
2017: SEVENTY FIVE STATE STREET 2017 401k membership
Total participants, beginning-of-year 2017-01-01 72
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 67
Number of retired or separated participants receiving benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 72
Total participants 2017-01-01 72

Measure	Date	Value
2017: SEVENTY FIVE STATE STREET 2017 401k membership
Total participants, beginning-of-year	2017-01-01	72
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	67
Number of retired or separated participants receiving benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	72
Total participants	2017-01-01	72

Form 5500 Responses for SEVENTY FIVE STATE STREET

2017: SEVENTY FIVE STATE STREET 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 )

Policy contract number

00A563

Policy instance

Insurance contract or identification number	00A563
Number of Individuals Covered	60
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,769
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	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 $441,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,769
Insurance broker organization code?	3
Insurance broker name	THE HOLDEN AGENCY

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

AL00003709

Policy instance

Insurance contract or identification number	AL00003709
Number of Individuals Covered	61
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,453
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $27,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,453
Insurance broker organization code?	3
Insurance broker name	THE HOLDEN AGENCY

Potentially related plans

SEVENTY FIVE HUNDRED YORK 401(K) RETIREMENT PLAN [EIN = 411340458]

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	SEVENTY-FIVE STATE STREET
Employer identification number (EIN):	010211791
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities