401k Plan data: BONACIO HEALTH INSURANCE PLAN plan

BONACIO HEALTH INSURANCE PLAN 401k Plan overview

Plan Name	BONACIO HEALTH INSURANCE PLAN
Plan identification number	502

BONACIO HEALTH INSURANCE PLAN Benefits

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

401k Sponsoring company profile

BONACIO CONSTRUCTION, INC has sponsored the creation of one or more 401k plans.

Company Name: BONACIO CONSTRUCTION, INC

Employer identification number (EIN): 141735519

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BONACIO HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2019-09-01
502 2018-09-01
502 2017-09-01
502 2017-09-01
502 2016-09-01
502 2015-09-01 JESSICA TIECKELMANN

Plan Statistics for BONACIO HEALTH INSURANCE PLAN

401k plan membership statisitcs for BONACIO HEALTH INSURANCE PLAN

Measure Date Value
2019: BONACIO HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 172
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 168
Number of retired or separated participants receiving benefits 2019-09-01 0
Number of other retired or separated participants entitled to future benefits 2019-09-01 0
Total of all active and inactive participants 2019-09-01 168
2018: BONACIO HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-09-01 102
Total number of active participants reported on line 7a of the Form 5500 2018-09-01 172
Number of retired or separated participants receiving benefits 2018-09-01 0
Number of other retired or separated participants entitled to future benefits 2018-09-01 0
Total of all active and inactive participants 2018-09-01 172
2017: BONACIO HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 104
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 102
Total of all active and inactive participants 2017-09-01 102
Total participants 2017-09-01 102
2016: BONACIO HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-09-01 102
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 104
Total of all active and inactive participants 2016-09-01 104
Total participants 2016-09-01 104
2015: BONACIO HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 102
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 216
Total of all active and inactive participants 2015-09-01 216
Total participants 2015-09-01 216

Measure	Date	Value
2019: BONACIO HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	172
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	168
Number of retired or separated participants receiving benefits	2019-09-01	0
Number of other retired or separated participants entitled to future benefits	2019-09-01	0
Total of all active and inactive participants	2019-09-01	168
2018: BONACIO HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-09-01	102
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	172
Number of retired or separated participants receiving benefits	2018-09-01	0
Number of other retired or separated participants entitled to future benefits	2018-09-01	0
Total of all active and inactive participants	2018-09-01	172
2017: BONACIO HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	104
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	102
Total of all active and inactive participants	2017-09-01	102
Total participants	2017-09-01	102
2016: BONACIO HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	102
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	104
Total of all active and inactive participants	2016-09-01	104
Total participants	2016-09-01	104
2015: BONACIO HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	102
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	216
Total of all active and inactive participants	2015-09-01	216
Total participants	2015-09-01	216

Form 5500 Responses for BONACIO HEALTH INSURANCE PLAN

2019: BONACIO HEALTH INSURANCE PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Submission has been amended	No
2019-09-01	This submission is the final filing	No
2019-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-09-01	Plan is a collectively bargained plan	No
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2018: BONACIO HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Submission has been amended	No
2018-09-01	This submission is the final filing	No
2018-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-09-01	Plan is a collectively bargained plan	No
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2017: BONACIO HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Submission has been amended	Yes
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
2016: BONACIO HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: BONACIO HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	First time form 5500 has been submitted	Yes
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

300206

Policy instance

Insurance contract or identification number	300206
Number of Individuals Covered	168
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $49,332
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $1,075,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,794
Insurance broker organization code?	3

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

300206

Policy instance

Insurance contract or identification number	300206
Number of Individuals Covered	172
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $43,246
Total amount of fees paid to insurance company	USD $9,512
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	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 $1,002,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $43,246
Amount paid for insurance broker fees	9512
Additional information about fees paid to insurance broker	CONTINGENT
Insurance broker organization code?	3

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )

Policy contract number

20031545

Policy instance

Insurance contract or identification number	20031545
Number of Individuals Covered	102
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $39,457
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $962,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	BONACIO CONSTRUCTION, INC
Employer identification number (EIN):	141735519
NAIC Classification:	236200