401k Plan data: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN plan

QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN
Plan identification number	501

QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

QUALITY SERVICE GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: QUALITY SERVICE GROUP, LLC

Employer identification number (EIN): 204917867

NAIC Classification: 722410
NAIC Description: Drinking Places (Alcoholic Beverages)

Additional information about QUALITY SERVICE GROUP, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2005-07-28

Company Identification Number: L05000074338

Legal Registered Office Address: 477 S ROSEMARY AVE

WEST PALM BEACH

33401

More information about QUALITY SERVICE GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01
501 2017-01-01 MEREDITH SHEARON 2019-06-04
501 2016-01-01 MEREDITH SHEARON
501 2015-01-01 MEREDITH SHEARON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2017-01-01
501	2017-01-01	MEREDITH SHEARON	2019-06-04
501	2016-01-01	MEREDITH SHEARON
501	2015-01-01	MEREDITH SHEARON

Plan Statistics for QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN

Measure Date Value
2017: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 102
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 103
Number of employers contributing to the scheme 2017-01-01 0
2016: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 117
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 118
2015: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 124
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 124

Measure	Date	Value
2017: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	102
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	103
Number of employers contributing to the scheme	2017-01-01	0
2016: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	117
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	118
2015: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	124
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	124

Form 5500 Responses for QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN

2017: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: QUALITY SERVICE GROUP, LLC EMPLOYEE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

99527061001

Policy instance

Insurance contract or identification number	99527061001
Number of Individuals Covered	78
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $966
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $966
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

608789

Policy instance

Insurance contract or identification number	608789
Number of Individuals Covered	59
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,014
Total amount of fees paid to insurance company	USD $186
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,014
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SERVICE/GENERAL AGENT PAYMENTS
Insurance broker name	WELLS FARGO INSURANCE

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Company Name:	QUALITY SERVICE GROUP, LLC
Employer identification number (EIN):	204917867
NAIC Classification:	722410
NAIC Description:	Drinking Places (Alcoholic Beverages)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2005-07-28
Company Identification Number:	L05000074338
Legal Registered Office Address:	477 S ROSEMARY AVE WEST PALM BEACH 33401